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

*Corresponding author for this work

Research output: Contribution to journalArticle

8 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

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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