title: Temporal trends in early clinical outcomes and health care resource utilization for liver transplantation in the United States.
abstract: BACKGROUND
  Procedures such as liver transplantation, which entail large costs while benefiting only a small percentage of the population, are being increasingly scrutinized by third-party payors. The purpose of our study was to conduct a longitudinal analysis of the early clinical outcomes and health care resource utilization for liver transplantation in the United States.
  
  
  METHODS
  The Nationwide Inpatient Sample database was used to conduct a longitudinal analysis of the clinical outcome and resource utilization data for liver transplantation procedures in adult recipients performed in the United States over three time periods (Period I: 1988-1993; Period II: 1994-1998: Period III: 1999-2003).
  
  
  RESULTS
  Compared to Period I, adult liver transplant recipients were more likely to be male, older, and non-White in Period III. Recipients were more likely to have at least one major comorbidity preoperatively than in Period I. The in-hospital mortality rate after liver transplantation decreased significantly from Period I to Period III, but the major intraoperative and postoperative complication rates increased over the same time period. Mean length of hospital stay decreased over the 15-year period, but the percentage of patients with a non-routine discharge status increased.
  
  
  CONCLUSIONS
  Our findings indicate that the rate of postoperative complications and non-routine discharges after liver transplantation is increasing. However, these negative changes in the cost-outcomes relationship for liver transplantation are balanced by improving postoperative survival rates and reductions in the length of hospital stay.
authors: Department of Surgery, Division of General Surgery, Duke University Medical Center, Durham, NC, 27710, USA. scarb005@mc.duke.edu
authors: John E
authors: JE
authors: Scarborough
authors: Ricardo
authors: R
authors: Pietrobon
authors: Carlos E
authors: CE
authors: Marroquin
authors: Janet E
authors: JE
authors: Tuttle-Newhall
authors: Paul C
authors: PC
authors: Kuo
authors: Bradley H
authors: BH
authors: Collins
authors: Dev M
authors: DM
authors: Desai
authors: Theodore N
authors: TN
authors: Pappas
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008107:Liver Diseases / Q000191:economics / Q000601:surgery; D016031:Liver Transplantation / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D012044:Regression Analysis; D013997:Time Factors; D014481:United States / Q000453:epidemiology