Ammori John B, Pelletier Shawn J, Lynch Raymond, Cohn Joshua, Ads Yasser, Campbell Darrell A, Englesbe Michael J
Department of Surgery, University of Michigan, Ann Arbor, MI 48109-0331, USA.
J Am Coll Surg. 2008 Jan;206(1):89-95. doi: 10.1016/j.jamcollsurg.2007.06.292. Epub 2007 Sep 18.
Complications after liver transplantation are common and expensive. The incremental costs of adult posttransplantation liver transplantation complications and who pays for these complications (center or payor) is unknown.
We reviewed the medical and financial records (first 90 postoperative days) of all adult liver transplant recipients at our center between July 1, 2002, and October 30, 2005 (N = 214). The association of donor, recipient, and financial data points (total costs, reimbursements, and profits) was assessed using standard univariable analyses. The incremental costs of complications were determined with multiple linear regression models to control for the costs inherent to donor and recipient characteristics.
Univariate analyses demonstrated that both total hospital costs and reimbursements were substantially increased in patients with several different complications. Multiple linear regression analysis, controlling for recipient (age, gender, race, and laboratory Model for End-Stage Liver Disease [MELD]) and donor factors (donor risk index), noted that increased hospital costs and hospital reimbursements were independently associated with laboratory MELD (incremental costs of $3,368 and $2,787, respectively, per MELD point) and pneumonia ($83,718 and $68,214, respectively). A negative profit margin for the medical center was independently associated with peritonitis ($21,760). Commercial insurance was associated with no changes in total costs when compared with public insurer, but it was associated with decreased reimbursement and profit.
The incremental costs of complications in liver transplantation are high for both the medical center and payor, but medical center profits are not affected substantially. The payor bears the financial burden for post-liver transplantation complications.
肝移植后的并发症很常见且费用高昂。成人肝移植术后并发症的增量成本以及这些并发症由谁来承担费用（中心还是付款方）尚不清楚。
我们回顾了2002年7月1日至2005年10月30日期间在本中心接受肝移植的所有成年患者的医疗和财务记录（术后前90天）（N = 214）。使用标准单变量分析评估供体、受体和财务数据点（总成本、报销费用和利润）之间的关联。通过多元线性回归模型确定并发症的增量成本，以控制供体和受体特征所固有的成本。
单变量分析表明，患有几种不同并发症的患者的总住院费用和报销费用均大幅增加。多元线性回归分析在控制受体因素（年龄、性别、种族和终末期肝病实验室模型 [MELD]）和供体因素（供体风险指数）后指出，住院费用增加和住院报销费用增加分别与实验室MELD（每MELD点增量成本分别为3368美元和2787美元）和肺炎（分别为83718美元和68214美元）独立相关。医疗中心的负利润率与腹膜炎独立相关（21760美元）。与公共保险公司相比，商业保险与总成本的变化无关，但与报销费用和利润的减少有关。
肝移植并发症的增量成本对医疗中心和付款方来说都很高，但医疗中心的利润并未受到实质性影响。付款方承担肝移植后并发症的财务负担。
