title: Who pays for biliary complications following liver transplant? A business case for quality improvement.
abstract: We use biliary complication following liver transplantation to quantify the financial implications of surgical complications and make a case for surgical improvement initiatives as a sound financial investment. We reviewed the medical and financial records of all liver transplant patients at the UMHS between July 1, 2002 and June 30, 2005 (N = 256). The association of donor, transplant, recipient and financial data points was assessed using both univariable (Student's t-test, a chi-square and logistic regression) and multivariable (logistic regression) methods. UMHS made a profit of $6822 +/- 39087 on patients without a biliary complication while taking a loss of $5742 +/- 58242 on patients with a biliary complication (p = 0.04). Reimbursement by the payer was $5562 higher in patients with a biliary complication compared to patients without a biliary complication (p = 0.001). Using multivariable logistic regression analysis, the two independent risk factors for a negative margin included private insurance (compared to public) (OR 1.88, CI 1.10-3.24, p = 0.022) and biliary leak (OR = 2.09, CI 1.06-4.13, p = 0.034). These findings underscore the important impact of surgical complications on transplant finances. Medical centers have a financial interest in transplant surgical quality improvement, but payers have the most to gain with improved surgical outcomes.
authors.affiliation: Department of Surgery, Division of Transplantation, University of Michigan Health System, Ann Arbor, Michigan, USA. englesbe@med.umich.edu
authors.forename: M J
authors.initials: MJ
authors.lastname: Englesbe
authors.forename: J
authors.initials: J
authors.lastname: Dimick
authors.forename: A
authors.initials: A
authors.lastname: Mathur
authors.forename: Y
authors.initials: Y
authors.lastname: Ads
authors.forename: T H
authors.initials: TH
authors.lastname: Welling
authors.forename: S J
authors.initials: SJ
authors.lastname: Pelletier
authors.forename: D G
authors.initials: DG
authors.lastname: Heidt
authors.forename: J C
authors.initials: JC
authors.lastname: Magee
authors.forename: R S
authors.initials: RS
authors.lastname: Sung
authors.forename: J D
authors.initials: JD
authors.lastname: Punch
authors.forename: D W
authors.initials: DW
authors.lastname: Hanto
authors.forename: D A
authors.initials: DA
authors.lastname: Campbell
mesh_terms: D000328:Adult; D005260:Female; D005705:Gallbladder Diseases / Q000191:economics* / Q000209:etiology*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000592:standards; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000191:economics*; D012051:Reimbursement Mechanisms