title: Clinical outcomes and costs associated with in-hospital biliary complications after liver transplantation: a cross-sectional analysis.
abstract: BACKGROUND
  In-hospital biliary complications (BCs) after liver transplantation (LT) are reported in up to 20 % of patients and contribute to poor outcomes and increased costs. Existing single-center outcome and cost analyses studies are limited in scope.
  
  
  METHODS
  This is a cross-sectional analysis of national data involving 7,967 patients transplanted between 2011 and 2012 with the primary aim of determining the association between BCs and clinical outcomes and costs. Age, race, diagnosis, and severity of illness are associated with the development of BCs.
  
  
  RESULTS
  BCs develop in 14.6 % of LT recipients and have substantial implications for perioperative outcomes, including length of hospital and ICU stay (27.9 vs 19.6 mean days, p < 0.001 and 12.0 vs 8.3 mean days, p < 0.001, respectively), in-hospital morbidity (39 vs 27 %, p < 0.001), 30-day readmissions (14.8 vs 11.2 %, p < 0.001), and in-hospital mortality (5.8 vs 4.0 %, p < 0.001). BCs contributed to a mean increase in in-hospital costs of $36,212 (p < 0.001), due to increases in accommodations ($9,539, p < 0.001), surgical services ($3,988, p < 0.001), and pharmacy services ($8,445, p < 0.001).
  
  
  CONCLUSIONS
  BCs are a predominant etiology for in-hospital morbidity and mortality, while contributing significantly to the high cost of LT. Efforts should be focused on understanding salient and modifiable risk factors, while developing innovative strategies to reduce BCs.
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 412, Charleston, SC, 29425, USA, arunp@musc.edu.
authors.forename: Arun P
authors.initials: AP
authors.lastname: Palanisamy
authors.forename: D J
authors.initials: DJ
authors.lastname: Taber
authors.forename: A G
authors.initials: AG
authors.lastname: Sutter
authors.forename: S N
authors.initials: SN
authors.lastname: Nadig
authors.forename: J E
authors.initials: JE
authors.lastname: Dowden
authors.forename: J W
authors.initials: JW
authors.lastname: McGillicuddy
authors.forename: P K
authors.initials: PK
authors.lastname: Baliga
authors.forename: K D
authors.initials: KD
authors.lastname: Chavin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000191:economics* / Q000209:etiology*; D003430:Cross-Sectional Studies; D004180:Direct Service Costs; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult