Healthcare utilization after liver transplantation is highly variable among both centers and recipients

T. Bittermann, R. A. Hubbard, M. Serper, J. D. Lewis, S. F. Hohmann, L. B. VanWagner, D. S. Goldberg

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

The relationship between healthcare utilization before and after liver transplantation (LT), and its association with center characteristics, is incompletely understood. This was a retrospective cohort study of 34 402 adult LTs between 2002 and 2013 using Vizient inpatient claims data linked to the United Network for Organ Sharing (UNOS) database. Multivariable mixed-effects linear regression models evaluated the association between hospitalization 90 days pre-LT and the number of days alive and out of the hospital (DAOH) 1 year post-LT. Of those patients alive at LT discharge, 24.7% spent ≥30 days hospitalized during the first year. Hospitalization in the 90 days pre-LT was inversely associated with DAOH (β = −3.4 DAOH/week hospitalized pre-LT; P =.002). Centers with >30% of their liver transplant recipients hospitalized ≥30 days in the first LT year were typically smaller volume and/or transplanting higher risk recipients (Model for End-Stage Liver Disease [MELD] score ≥35, inpatient or ventilated pre-LT). In conclusion, pre-LT hospitalization predicts 1-year post-LT hospitalization independent of MELD score at the patient-level, whereas center-specific post-LT healthcare utilization is associated with certain center behaviors and selection practices.

Original languageEnglish (US)
Pages (from-to)1197-1205
Number of pages9
JournalAmerican Journal of Transplantation
Volume18
Issue number5
DOIs
StatePublished - May 2018
Externally publishedYes

Keywords

  • clinical decision-making
  • clinical research/practice
  • comorbidities
  • health services and outcomes research
  • hospital readmission
  • liver transplantation/hepatology
  • patient characteristics
  • patient survival

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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