title: Variation in resource utilization in liver transplantation at freestanding children's hospitals.
abstract: We sought to examine the relationship between liver transplant-related total cost, patient outcome, and hospital resource utilization at freestanding children's hospitals. Using the PHIS database, a retrospective study of 374 patients that underwent liver transplantation at 15 freestanding children's hospitals from July 2010 to December 2012 was performed. One-year graft failure and patient mortality rates from July 2010 to December 2012 for each center were also obtained from the SRTR. There was a 5.1-fold difference in median cost (median $146 444, range $59 487-302 058, P<.001) between all centers. A 2.4-fold difference existed in median LOS (median 15 days, range 9-22 days, P<.001) across centers. Median postoperative ICU stay varied from 0 to 7 days (median 4 days, P<.001). Overall, 30-day readmission rate was 55% (31.3%-100%, P<.001). One-year graft failure varied from 0% to 19.1%, with an overall rate of 5.5% (P=.279). One-year patient mortality for all centers was 2.3% (range 0%-11.1%, P=.016). Higher total cost did not correlate with lower readmission rates, patient mortality, graft failure, or any other variable. These data suggest that identifying practice patterns at low-cost centers and implementing them at higher-cost centers may decrease the cost of pediatric liver transplantation without compromising outcomes.
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Minneman
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Grijalva
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: LaQuaglia
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Heung Bae
authors.initials: HB
authors.lastname: Kim
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA. khashayar.vakili@childrens.harvard.edu.
authors.forename: Khashayar
authors.initials: K
authors.lastname: Vakili
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D058625:End Stage Liver Disease / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D017048:Health Care Costs; D006776:Hospitals, Pediatric / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D007902:Length of Stay; D016031:Liver Transplantation / Q000191:economics*; D008297:Male; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D012189:Retrospective Studies
keywords: cost; liver transplant; liver transplantation; outcome; pediatric liver transplantation; resource utilization; survival