title: Increased resource use in lung transplant admissions in the lung allocation score era.
abstract: BACKGROUND
  In 2005, the lung allocation score (LAS) was implemented to prioritize organ allocation to minimize waiting-list mortality and maximize 1-year survival. It resulted in transplantation of older and sicker patients without changing 1-year survival. Its effect on resource use is unknown.
  
  
  OBJECTIVE
  To determine changes in resource use over time in lung transplant admissions.
  
  
  METHODS
  Solid organ transplant recipients were identified within the Nationwide Inpatient Sample (NIS) data from 2000 to 2011. Joinpoint regression methodology was performed to identify a time point of change in mean total hospital charges among lung transplant and other solid-organ transplant recipients. Two temporal lung transplant recipient cohorts identified by joinpoint regression were compared for baseline characteristics and resource use, including total charges for index hospitalization, charges per day, length of stay, discharge disposition, tracheostomy, and need for extracorporeal membrane oxygenation.
  
  
  RESULTS
  A significant point of increased total hospital charges occurred for lung transplant recipients in 2005, corresponding to LAS implementation, which was not seen in other solid-organ transplant recipients. Total transplant hospital charges increased by 40% in the post-LAS cohort ($569,942 [$53,229] vs. $407,489 [$28,360]) along with an increased median length of stay, daily charges, and discharge disposition other than to home. Post-LAS recipients also had higher post-transplant use of extracorporeal membrane oxygenation (odds ratio, 2.35; 95% confidence interval, 1.56-3.55) and higher incidence of tracheostomy (odds ratio, 1.52; 95% confidence interval, 1.22-1.89).
  
  
  CONCLUSIONS
  LAS implementation is associated with a significant increase in resource use during index hospitalization for lung transplant.
authors.affiliation: 1 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Maxwell
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Mooney
authors.forename: Peter H U
authors.initials: PH
authors.lastname: Lee
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Levitt
authors.forename: Laveena
authors.initials: L
authors.lastname: Chhatwani
authors.forename: Mark R
authors.initials: MR
authors.lastname: Nicolls
authors.forename: Martin R
authors.initials: MR
authors.lastname: Zamora
authors.forename: Vincent
authors.initials: V
authors.lastname: Valentine
authors.forename: David
authors.initials: D
authors.lastname: Weill
authors.forename: Gundeep S
authors.initials: GS
authors.lastname: Dhillon
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000191:economics; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008171:Lung Diseases / Q000191:economics* / Q000601:surgery; D016040:Lung Transplantation / Q000191:economics* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics; D010351:Patient Discharge / Q000191:economics; D018579:Patient Selection; D009927:Tissue and Organ Procurement / Q000191:economics; D014481:United States; D014850:Waiting Lists
keywords: Nationwide Inpatient Sample; lung allocation score; lung transplant; lung transplant cost; solid-organ transplant