Inpatient economic and mortality assessment for liver transplantation: a nationwide study of the United States data from 2005 to 2009.
BACKGROUND
Liver transplantation is a standard of care for treatment of end-stage liver disease. The aim of this study was to evaluate resource utilization for patients admitted to the U.S. hospitals for liver transplantation from 2005 to 2009.


METHODS
Nationwide inpatient sample was used.


RESULTS
A total of 5527 hospital admissions were included to the study cohort approximating 27,350 procedures nationwide (compared with 32,228 reported by United Network for Organ Sharing). Approximately 75% of patients had major or extreme severity of illness (All Patient Refined Diagnosis-Related Groups). The most prevalent comorbidities were coagulopathy (36.0%), fluid and electrolyte disorders (39.8%), anemia (18.7%), and type 2 diabetes (23.8%). Furthermore, 5.1% patients died in the hospital, 80.0% were discharged routinely or to home healthcare, and 14.9% were transferred to other healthcare facilities. The mean number of inpatient procedures was 7.2, and 3.5 were minimal therapeutic. The mean length of hospitalization was 22.2 days, the mean hospital charges were $358,200, and the mean inpatient costs of liver transplantation were $114,300. In multivariate analysis, the most significant factors associated with longer stay were younger age, major or extreme severity of illness, and more procedures performed during hospitalization. Similar factors were also associated with higher cost of inpatient treatment. Inpatient mortality, however, was associated only with more severe illness and more procedures while being inversely associated with younger age and higher income.


CONCLUSIONS
Liver transplantation is a life-saving procedure with significant economic burden to our society. Severity of illness is the common driver of both in hospital mortality and resource utilization.
1 Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA. 2 University of California-Los Angeles School of Medicine, Los Angeles, CA. 3 Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA. 4 Address correspondence to: Zobair M. Younossi, M.D., M.P.H., Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building, 3300 Gallows Road, Falls Church, VA 22042.
Homan
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Wai
Maria
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Stepanova
Sammy
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Saab
Madeline
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Erario
Manirath
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Srishord
Zobair M
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Younossi
D000367:Age Factors; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics; D016014:Linear Models; D008107:Liver Diseases / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics* / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000191:economics; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States