Effects of obesity, diabetes, and prior abdominal surgery on resource utilization in liver transplantation: a single-center study.
Obesity, diabetes, and prior abdominal surgery are generally considered to increase the risk of liver transplantation. The aim of the present study was to define the effects of these factors on the immediate outcome after transplantation. Two hundred twenty-one consecutive liver transplants were analyzed. Twenty-eight patients were excluded. In the remaining 193 patients [mean age = 52 +/- 19 years, body mass index (BMI) = 28.5, Model for End-Stage Liver Disease (MELD) score at listing = 18.7], the risk from obesity was graded as follows: (0) BMI < or = 30, (1) BMI = 30-34.9, (2) BMI = 35-39.9, and (3) BMI > or =40. The presence of diabetes and prior abdominal surgery were each given 1 point. All the individual scores for obesity, diabetes, and prior surgery were added to produce a composite risk score for each patient. Patients were categorized into 6 risk groups, group 0 having the least risk and group 5 having the highest risk (none of the patients were in group 5). The outcome measures were death, reoperation, readmission within 90 days of transplantation, intensive care unit length of stay (LOS), hospital LOS, and packed red blood cell requirement in 48 hours. The 5 risk score groups with patients were similar in demographics and calculated MELD scores. The outcome measures in high-risk groups were similar to those in the lowest-risk group (score = 0). In the Cox regression model for LOS and survival, the composite risk score was not associated with poor survival or prolonged LOS (>3 weeks). Kaplan-Meier survival curves with log rank testing failed to show any difference in survival among different risk groups. In conclusion, patients with multiple risk factors for poor surgical outcomes can undergo successful transplantation with perioperative outcome and mortality comparable to those of low-risk patients.
Nair
Satheesh
S
University of Tennessee Health Science Center, Memphis, TN 38163, USA. snair@utmem.edu
Vanatta
Jason M
JM
Arteh
Jihad
J
Eason
James D
JD
D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003422:Critical Care / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D017093:Liver Failure / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000401:mortality*; D010359:Patient Readmission / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors