TY - JOUR
T1 - Readmission to the intensive care unit after liver transplantation
AU - Levy, Marlon F.
AU - Greene, Lonnie
AU - Ramsay, Michael A E
AU - Jennings, Linda W.
AU - Ramsay, Kirsten J.
AU - Meng, Jin
AU - Tillmann Hein, H. A.
AU - Goldstein, Robert M.
AU - Husberg, Bo S.
AU - Gonwa, Thomas A.
AU - Klintmalm, Goran B.
PY - 2001
Y1 - 2001
N2 - Objective: We undertook this study to understand the factors at our transplant center that contribute to patients' return to the ICU after their liver transplant and their initial discharge from that unit. Patients who, after liver transplantation, fail discharge from the Intensive Care Unit (ICU) and must be readmitted to that unit may well utilize many more resources than those patients who are well enough to stay out of the ICU. Design: A retrospective review of a prospectively maintained liver transplant research database followed by a retrospective review of (a subgroup) patient charts and contemporaneous controls. Setting: A large metropolitan tertiary care center and adult liver transplant center. Patients: A total of 1,197 consecutive adult patients who underwent their initial liver transplantation from 1984 to 1996. Intervention: Readmission to the intensive care unit after adult liver transplantation and discharge from that unit. Main Results: Only recipient age, pretransplant synthetic function labs (protime and albumin), bilirubin levels, and intraoperative blood product requirements could be statistically linked to the group requiring ICU readmission. The primary etiology for ICU readmission was cardiopulmonary deterioration. Readmission was associated with significantly lower patient and graft survivals. A detailed review of 23 patients transplanted from October 1994 to June 1996 was made, with special emphasis on cardiopulmonary status (hemodynamics, respiratory variables, and chest radiograph findings). This subgroup was compared with 30 temporally matched controls who were not readmitted to the ICU. Intravascular fluid overload and lower inspiratory capacity were significant factors related to ICU readmission. Readmitted patients had a longer hospitalization with higher hospital charges than the control group. Conclusions: We conclude that the most important means of preventing ICU readmission in liver transplantation patients is to optimize cardiopulmonary function and status. Close monitoring of fluid balance to avoid hypervolemia is essential. Readmitted patients have a greater resource utilization and have lower survival rates.
AB - Objective: We undertook this study to understand the factors at our transplant center that contribute to patients' return to the ICU after their liver transplant and their initial discharge from that unit. Patients who, after liver transplantation, fail discharge from the Intensive Care Unit (ICU) and must be readmitted to that unit may well utilize many more resources than those patients who are well enough to stay out of the ICU. Design: A retrospective review of a prospectively maintained liver transplant research database followed by a retrospective review of (a subgroup) patient charts and contemporaneous controls. Setting: A large metropolitan tertiary care center and adult liver transplant center. Patients: A total of 1,197 consecutive adult patients who underwent their initial liver transplantation from 1984 to 1996. Intervention: Readmission to the intensive care unit after adult liver transplantation and discharge from that unit. Main Results: Only recipient age, pretransplant synthetic function labs (protime and albumin), bilirubin levels, and intraoperative blood product requirements could be statistically linked to the group requiring ICU readmission. The primary etiology for ICU readmission was cardiopulmonary deterioration. Readmission was associated with significantly lower patient and graft survivals. A detailed review of 23 patients transplanted from October 1994 to June 1996 was made, with special emphasis on cardiopulmonary status (hemodynamics, respiratory variables, and chest radiograph findings). This subgroup was compared with 30 temporally matched controls who were not readmitted to the ICU. Intravascular fluid overload and lower inspiratory capacity were significant factors related to ICU readmission. Readmitted patients had a longer hospitalization with higher hospital charges than the control group. Conclusions: We conclude that the most important means of preventing ICU readmission in liver transplantation patients is to optimize cardiopulmonary function and status. Close monitoring of fluid balance to avoid hypervolemia is essential. Readmitted patients have a greater resource utilization and have lower survival rates.
KW - Costs
KW - Intensive care unit readmission
KW - Liver transplantation
KW - Pulmonary function
KW - Resource utilization
UR - http://www.scopus.com/inward/record.url?scp=0035141257&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0035141257&partnerID=8YFLogxK
U2 - 10.1097/00003246-200101000-00004
DO - 10.1097/00003246-200101000-00004
M3 - Article
C2 - 11176152
AN - SCOPUS:0035141257
SN - 0090-3493
VL - 29
SP - 18
EP - 24
JO - Critical care medicine
JF - Critical care medicine
IS - 1
ER -