title: National assessment of early biliary complications after liver transplantation: economic implications.
abstract: BACKGROUND
  Despite improvement in surgical technique and medical management of liver transplant recipients, biliary complications remain a frequent cause of posttransplant morbidity and graft loss. Biliary complications require potentially expensive interventions including radiologic procedures and surgical revisions.
  
  
  METHODS
  A national data set linking transplant registry and Medicare claims data for 12,803 liver transplant recipients was developed to capture information on complications, treatments, and associated direct medical costs up to 3 years after transplantation.
  
  
  RESULTS
  Biliary complications were more common in recipients of donation after cardiac death compared to donation after brain death allografts (23% vs. 19% P<0.001). Among donation after brain death recipients, biliary complications were associated with $54,699 (95% confidence interval [CI], $49,102 to $60,295) of incremental spending in the first year after transplantation and $7,327 in years 2 and 3 (95% CI, $4,419-$10,236). Biliary complications in donation after cardiac death recipients independently increased spending by $94,093 (95% CI, $64,643-$124,542) in the first year and $12,012 (95% CI, $-1,991 to $26,016) in years 2 and 3.
  
  
  CONCLUSIONS
  This national study of biliary complications demonstrates the significant economic impact of this common perioperative complication and suggests a potential target for quality of care improvements.
authors.affiliation: 1 Section of Transplant Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. 2 Center for Outcome Research, St. Louis University, St. Louis, MO. 3 Department of Surgery, St. Louis University, St. Louis, MO. 4 Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD. 5 Address correspondence to: David A. Axelrod, M.D., MBA, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756.
authors.forename: David A
authors.initials: DA
authors.lastname: Axelrod
authors.forename: Nino
authors.initials: N
authors.lastname: Dzebisashvilli
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
authors.forename: Huiling
authors.initials: H
authors.lastname: Xiao
authors.forename: Mark
authors.initials: M
authors.lastname: Schnitzler
authors.forename: Janet E
authors.initials: JE
authors.lastname: Tuttle-Newhall
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000191:economics / Q000209:etiology*; D001926:Brain Death; D015331:Cohort Studies; D003643:Death; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D017093:Liver Failure / Q000150:complications / Q000191:economics / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000191:economics*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D011787:Quality of Health Care; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult