Temporal trends in early clinical outcomes and health care resource utilization for liver transplantation in the United States.
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.
Scarborough
John E
JE
Department of Surgery, Division of General Surgery, Duke University Medical Center, Durham, NC, 27710, USA. scarb005@mc.duke.edu
Pietrobon
Ricardo
R
Marroquin
Carlos E
CE
Tuttle-Newhall
Janet E
JE
Kuo
Paul C
PC
Collins
Bradley H
BH
Desai
Dev M
DM
Pappas
Theodore N
TN
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