title: Predicting early discharge from hospital after liver transplantation (ERDALT) at a single center: a new model.
abstract: OBJECTIVE
  Limited information related to Liver Transplantation (LT) costs in South America exists. Additionally, costs analysis from developed countries may not provide comparable models for those in emerging economies. We sought to evaluate a predictive model of Early Discharge from Hospital after LT (ERDALT = length of hospital stay ≤ 8 days). A predictive model was assessed based on the odds ratios (OR) from a multivariate regression analysis in a cohort of consecutively transplanted adult patients in a single center from Argentina and internally validated with bootstrapping technique.
  
  
  RESULTS
  ERDALT was applicable in 34 of 289 patients (11.8%). Variables independently associated with ERDALT were MELD exception points OR 1.9 (P = 0.04), surgery time < 4 h OR 3.8 (P = 0.013), < 5 units of blood products consumption (BPC) OR 3.5 (P = 0.001) and early weaning from mechanical intubation OR 6.3 (P = 0.006). Points in the predictive scoring model were allocated as follows: MELD exception points (absence = 0 points, presence = 1 point), surgery time < 4 h (0-2 points), < 5 units of BPC (0-2 points), and early weaning (0-3 points). Final scores ranged from 0 to 8 points with a c-statistic of 0.83 (95% CI 0.77-0.90; P < 0.0001). Transplant costs were significantly lower in patients with ERDALT (median $23,078 vs. $28,986; P < 0.0001). Neither lower patient and graft survival, nor higher rates of short-term re-hospitalization and acute rejection events after discharge were observed in patients with ERDALT. In conclusion, the ERDALT score identifies patients suitable for early discharge with excellent outcomes after transplantation. This score may provide applicable models particularly for emerging economies.
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina.
authors.forename: Federico
authors.initials: F
authors.lastname: Piñero
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina.
authors.forename: Martín
authors.initials: M
authors.lastname: Fauda
authors.affiliation: Internal Medicine, Infectious Diseases and Statistics. Hospital Universitario Austral, Buenos Aires, Argentina.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Quiros
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina.
authors.forename: Manuel
authors.initials: M
authors.lastname: Mendizabal
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina.
authors.forename: Ariel
authors.initials: A
authors.lastname: González-Campaña
authors.affiliation: Intensive Care Unit. Hospital Universitario Austral, Buenos Aires, Argentina.
authors.forename: Demian
authors.initials: D
authors.lastname: Czerwonko
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina.
authors.forename: Mariano
authors.initials: M
authors.lastname: Barreiro
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina.
authors.forename: Silvina
authors.initials: S
authors.lastname: Montal
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina.
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Silberman
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina.
authors.forename: Matías
authors.initials: M
authors.lastname: Coronel
authors.affiliation: Department of Anesthesiology. Hospital Universitario Austral, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Cacheiro
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina.
authors.forename: Pía
authors.initials: P
authors.lastname: Raffa
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina.
authors.forename: Oscar
authors.initials: O
authors.lastname: Andriani
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Silva
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina.
authors.forename: Luis G
authors.initials: LG
authors.lastname: Podestá
mesh_terms: D000328:Adult; D000368:Aged; D001118:Argentina; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006085:Graft Survival; D017721:Hospital Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000191:economics; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D061646:Operative Time; D010351:Patient Discharge / Q000191:economics; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015300:Ventilator Weaning