Hospital length of stay after lung transplantation: Independent predictors and association with early and late survival

Research output: Contribution to journalArticle

14 Citations (Scopus)

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.

Original languageEnglish (US)
JournalJournal of Heart and Lung Transplantation
DOIs
StateAccepted/In press - 2016

Fingerprint

Lung Transplantation
Length of Stay
Survival
Tissue Donors
Confidence Intervals
Extracorporeal Membrane Oxygenation
Mechanical Ventilators
Serum Albumin
African Americans
Hospitalization
Body Mass Index
Transplantation
Databases
Transplants
Lung
Mortality

Keywords

  • 1-year survival
  • 5-year survival
  • Donor demographics
  • Ischemic time
  • Length of stay
  • Lung allocation score
  • Prolonged hospitalization

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

@article{5e20e295e2e3466dae61ca68dc2cd3bc,
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.",
keywords = "1-year survival, 5-year survival, Donor demographics, Ischemic time, Length of stay, Lung allocation score, Prolonged hospitalization",
author = "Amit Banga and Manish Mohanka and Jessica Mullins and Srinivas Bollineni and Vaidehi Kaza and Steve Ring and Pietro Bajona and Matthias Peltz and Michael Wait and Fernando Torres",
year = "2016",
doi = "10.1016/j.healun.2016.07.020",
language = "English (US)",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - Hospital length of stay after lung transplantation

T2 - Independent predictors and association with early and late survival

AU - Banga, Amit

AU - Mohanka, Manish

AU - Mullins, Jessica

AU - Bollineni, Srinivas

AU - Kaza, Vaidehi

AU - Ring, Steve

AU - Bajona, Pietro

AU - Peltz, Matthias

AU - Wait, Michael

AU - Torres, Fernando

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

KW - 1-year survival

KW - 5-year survival

KW - Donor demographics

KW - Ischemic time

KW - Length of stay

KW - Lung allocation score

KW - Prolonged hospitalization

UR - http://www.scopus.com/inward/record.url?scp=84994536710&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84994536710&partnerID=8YFLogxK

U2 - 10.1016/j.healun.2016.07.020

DO - 10.1016/j.healun.2016.07.020

M3 - Article

C2 - 27642060

AN - SCOPUS:84994536710

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

ER -