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 language | English (US) |
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Pages (from-to) | 1197-1205 |
Number of pages | 9 |
Journal | American Journal of Transplantation |
Volume | 18 |
Issue number | 5 |
DOIs | |
State | Published - May 2018 |
Externally published | Yes |
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)