title: Hospital length of stay after lung transplantation: Independent predictors and association with early and late survival.
abstract: BACKGROUND
  Duration of index hospitalization after lung transplantation (LTx) is an important variable that has not received much attention. We sought to determine independent predictors of prolonged hospital length of stay (LOS) and its association with early and late outcomes.
  
  
  METHODS
  The United Network of Organ Sharing database was queried for adult patients undergoing LTx between 2006 and 2014 (N = 14,320). Patients with dual organ or previous transplantation and patients who died during the first 25 days after LTx were excluded (n = 12,647, mean age 55.2 years ± 13.1). Primary outcome was prolonged LOS (>25 days) (3,251/12,647; 25.7%). Donor, recipient, and procedure-related variables were analyzed as potential predictors of prolonged LOS. Association of prolonged LOS with 1-year and 5-year survival was evaluated using Cox proportional hazards analysis.
  
  
  RESULTS
  Independent predictors of prolonged LOS included serum albumin, lung allocation score, functional status, and need of extracorporeal membrane oxygenation or ventilator support at the time of transplant; donor age >40 years; gender mismatch (female donor to male recipient); donor body mass index; African American ethnicity; ischemic time >6 hours; and double LTx. Prolonged LOS was independently associated with increased mortality at 1 year (hazard ratio, 3.96; 95% confidence interval, 3.48-4.50; p < 0.001) and 5 years (hazard ratio, 2.00; 95% confidence interval, 1.79-2.25; p < 0.001).
  
  
  CONCLUSIONS
  A significant proportion of patients have a prolonged LOS after LTx, and several recipient, donor, and procedure-related variables are independent predictors of this outcome. Patients with prolonged LOS after LTx have significantly increased risk of death at 1 year and 5 years.
authors.affiliation: Division of Pulmonary and Critical Care Medicine. Electronic address: amit.banga@utsouthwestern.edu.
authors.forename: Amit
authors.initials: A
authors.lastname: Banga
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Manish
authors.initials: M
authors.lastname: Mohanka
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Jessica
authors.initials: J
authors.lastname: Mullins
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Bollineni
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Vaidehi
authors.initials: V
authors.lastname: Kaza
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Steve
authors.initials: S
authors.lastname: Ring
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Pietro
authors.initials: P
authors.lastname: Bajona
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Matthias
authors.initials: M
authors.lastname: Peltz
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: Wait
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Fernando
authors.initials: F
authors.lastname: Torres
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data*; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D014481:United States
keywords: 1-year survival; 5-year survival; donor demographics; ischemic time; length of stay; lung allocation score; prolonged hospitalization