title: Do older patients utilize excess health care resources after liver transplantation?
abstract: BACKGROUND
  Liver transplantation is a highly effective treatment for end-stage liver disease. However, there is debate over the practice of liver transplantation in older recipients (age ≥ 60 years) given the relative shortage of donor grafts, worse post-transplantation survival, and concern that that older patients may utilize excess resources postoperatively, thus threatening the economic feasibility of the procedure.
  
  
  OBJECTIVE
  To determine if patients ≥ 60 years of age utilize more health resources following liver transplantation compared with younger patients.
  
  
  METHODS
  Consecutive adult patients who underwent primary liver transplantation (n = 208) at a single center were studied over a 2.5-year period. Data were collected on clinico-demographic characteristics and resource utilization. Descriptive statistics, including means, standard deviations, or frequencies were obtained for baseline variables. Patients were stratified into 2 groups: age ≥ 60 years (n = 51) and < 60 years (n = 157). The Chi-Square Test, Mantel-Haenszel Test, 2-sample test and odds ratios were calculated to ascertain associations between age and resource utilization parameters. Regression analyses were adjusted for model for end-stage liver disease score, location before surgery, diabetes mellitus, donor age, cold ischemia time, albumin, and diagnosis of hepatitis C.
  
  
  RESULTS
  Recipients ≥ 60 years of age have similar lengths of hospitalization, re-operative rates, need for consultative services and readmission rates following liver transplantation, but have longer lengths of stay in the intensive care (hazard ratio 1.97, p = 0.03).
  
  
  CONCLUSIONS
  Overall, liver transplant recipients ≥ 60 years of age utilize comparable resources following LT vs. younger recipients. Our findings have implications on cost-containment policies for liver transplantation.
authors.affiliation: Division of Gastroenterology, University of Western Ontario, London, Ontario, Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: Shankar
authors.forename: Mamoun
authors.initials: M
authors.lastname: AlBasheer
authors.forename: Paul
authors.initials: P
authors.lastname: Marotta
authors.forename: William
authors.initials: W
authors.lastname: Wall
authors.forename: Vivian
authors.initials: V
authors.lastname: McAlister
authors.forename: Natasha
authors.initials: N
authors.lastname: Chandok
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D003422:Critical Care / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009864:Ontario; D010359:Patient Readmission; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012044:Regression Analysis; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome