TY - JOUR
T1 - Temporal trends in early clinical outcomes and health care resource utilization for liver transplantation in the United States
AU - Scarborough, John E.
AU - Pietrobon, Ricardo
AU - Marroquin, Carlos E.
AU - Tuttle-Newhall, Janet E.
AU - Kuo, Paul C.
AU - Collins, Bradley H.
AU - Desai, Dev M.
AU - Pappas, Theodore N.
N1 - Funding Information:
The Nationwide Inpatient Sample (NIS) databases for the years 1988 thorough 2003 were used for our study.19The NIS is a part of the Healthcare Cost and Utilization Project (HCUP), sponsored by the Agency for Healthcare Research and Quality (AHRQ). The NIS is the largest all-payor inpatient care database that is publicly available in the United States and contains approximately 5 to 8 million records of inpatient stays per year from about 1,000 hospitals, which represent a 20% stratified sample of community hospitals in the United States.20 To ensure maximal representation of the US hospitals, the following sampling strata, based on five important hospital characteristics, were used for the creation of the NIS: geographic region (Northeast, North Central, West, and South), ownership (public, private not for profit, and private investor-owned), location (urban and rural), teaching status (teaching hospital and nonteaching hospital), and bed size (small, medium, and large).
PY - 2007/1
Y1 - 2007/1
N2 - Procedures such as liver transplantation, which entail large costs while benefiting only a small percentage of the population, are being increasingly scrutinized by third-party payors. The purpose of our study was to conduct a longitudinal analysis of the early clinical outcomes and health care resource utilization for liver transplantation in the United States. The Nationwide Inpatient Sample database was used to conduct a longitudinal analysis of the clinical outcome and resource utilization data for liver transplantation procedures in adult recipients performed in the United States over three time periods (Period I: 1988-1993; Period II: 1994-1998: Period III: 1999-2003). Compared to Period I, adult liver transplant recipients were more likely to be male, older, and non-White in Period III. Recipients were more likely to have at least one major comorbidity preoperatively than in Period I. The in-hospital mortality rate after liver transplantation decreased significantly from Period I to Period III, but the major intraoperative and postoperative complication rates increased over the same time period. Mean length of hospital stay decreased over the 15-year period, but the percentage of patients with a non-routine discharge status increased. Our findings indicate that the rate of postoperative complications and non-routine discharges after liver transplantation is increasing. However, these negative changes in the cost-outcomes relationship for liver transplantation are balanced by improving postoperative survival rates and reductions in the length of hospital stay.
AB - Procedures such as liver transplantation, which entail large costs while benefiting only a small percentage of the population, are being increasingly scrutinized by third-party payors. The purpose of our study was to conduct a longitudinal analysis of the early clinical outcomes and health care resource utilization for liver transplantation in the United States. The Nationwide Inpatient Sample database was used to conduct a longitudinal analysis of the clinical outcome and resource utilization data for liver transplantation procedures in adult recipients performed in the United States over three time periods (Period I: 1988-1993; Period II: 1994-1998: Period III: 1999-2003). Compared to Period I, adult liver transplant recipients were more likely to be male, older, and non-White in Period III. Recipients were more likely to have at least one major comorbidity preoperatively than in Period I. The in-hospital mortality rate after liver transplantation decreased significantly from Period I to Period III, but the major intraoperative and postoperative complication rates increased over the same time period. Mean length of hospital stay decreased over the 15-year period, but the percentage of patients with a non-routine discharge status increased. Our findings indicate that the rate of postoperative complications and non-routine discharges after liver transplantation is increasing. However, these negative changes in the cost-outcomes relationship for liver transplantation are balanced by improving postoperative survival rates and reductions in the length of hospital stay.
KW - Health care resource utilization
KW - Liver transplantation
KW - Longitudinal analysis
KW - Outcome assessment
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U2 - 10.1007/s11605-007-0103-5
DO - 10.1007/s11605-007-0103-5
M3 - Article
C2 - 17390192
AN - SCOPUS:34250211115
SN - 1091-255X
VL - 11
SP - 82
EP - 88
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 1
ER -