title: Risk of Reoperation Within 90 Days of Liver Transplantation: A Necessary Evil?
abstract: BACKGROUND
  The rate and consequences of reoperation after liver transplantation (LT) are unknown in the United States.
  
  
  METHODS
  Adult patients (n = 10,295; 45% of all LT) undergoing LT from 2009 through 2012 were examined using a linkage of the University HealthSystem Consortium and Scientific Registry of Transplant Recipients databases providing recipient, donor, center, hospitalization, and survival details. Median follow-up was 2 years. Reoperations were identified within 90 days after LT.
  
  
  RESULTS
  Overall 90-day reoperation rate after LT was 29.3%. Risk factors for 90-day reoperation included recipients with a history of hemodialysis, severely ill functional status, government insurance, increasing Model for End-Stage Liver Disease score, and increasing donor risk index. Reoperation within 90 days was found to be an independent predictor of adjusted 1-year mortality (odds ratio = 1.8; 95% CI, 1.5-2.1), as was government-provided insurance and increasing donor risk index. Additionally, patients undergoing delayed reoperative intervention (after 30 days) were found to have increased risk of 1-year mortality compared with those undergoing early reoperative intervention (odds ratio = 1.96; 95% CI, 1.4-2.7; p < 0.01).
  
  
  CONCLUSIONS
  This is the first national study reporting that nearly one-third of transplant recipients undergo reoperation within 90 days of LT. Although necessary at times, reoperation is associated with increased risk of death at 1 year; however, it appears that the timing of these interventions can be critical, due to the type of intervention required. Early reoperative intervention does not appear to influence long-term outcomes, and delayed intervention (after 30 days) is strongly associated with decreased survival.
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Cincinnati, OH; Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Audrey E
authors.initials: AE
authors.lastname: Ertel
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Cincinnati, OH; Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Koffi
authors.initials: K
authors.lastname: Wima
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Cincinnati, OH; Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Alex L
authors.initials: AL
authors.lastname: Chang
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Cincinnati, OH; Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hoehn
authors.affiliation: University Health Consortium, Chicago, IL; Department of Health Systems Management, Rush University, Chicago, IL.
authors.forename: Samual F
authors.initials: SF
authors.lastname: Hohmann
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Cincinnati, OH; Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Edwards
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Cincinnati, OH; Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Cincinnati, OH; Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH. Electronic address: Shimul.shah@uc.edu.
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012086:Reoperation; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult