Maxwell Bryan G, Mooney Joshua J, Lee Peter H U, Levitt Joseph E, Chhatwani Laveena, Nicolls Mark R, Zamora Martin R, Valentine Vincent, Weill David, Dhillon Gundeep S
1 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Am J Respir Crit Care Med. 2015 Feb 1;191(3):302-8. doi: 10.1164/rccm.201408-1562OC.
In 2005, the lung allocation score (LAS) was implemented to prioritize organ allocation to minimize waiting-list mortality and maximize 1-year survival. It resulted in transplantation of older and sicker patients without changing 1-year survival. Its effect on resource use is unknown.
To determine changes in resource use over time in lung transplant admissions.
Solid organ transplant recipients were identified within the Nationwide Inpatient Sample (NIS) data from 2000 to 2011. Joinpoint regression methodology was performed to identify a time point of change in mean total hospital charges among lung transplant and other solid-organ transplant recipients. Two temporal lung transplant recipient cohorts identified by joinpoint regression were compared for baseline characteristics and resource use, including total charges for index hospitalization, charges per day, length of stay, discharge disposition, tracheostomy, and need for extracorporeal membrane oxygenation.
A significant point of increased total hospital charges occurred for lung transplant recipients in 2005, corresponding to LAS implementation, which was not seen in other solid-organ transplant recipients. Total transplant hospital charges increased by 40% in the post-LAS cohort ($569,942 [$53,229] vs. $407,489 [$28,360]) along with an increased median length of stay, daily charges, and discharge disposition other than to home. Post-LAS recipients also had higher post-transplant use of extracorporeal membrane oxygenation (odds ratio, 2.35; 95% confidence interval, 1.56-3.55) and higher incidence of tracheostomy (odds ratio, 1.52; 95% confidence interval, 1.22-1.89).
LAS implementation is associated with a significant increase in resource use during index hospitalization for lung transplant.
2005年，实施了肺分配评分（LAS）以优化器官分配，从而将等待名单上的死亡率降至最低并使1年生存率最大化。这导致了年龄更大、病情更重的患者接受移植，但1年生存率并未改变。其对资源利用的影响尚不清楚。
确定肺移植入院患者资源利用随时间的变化。
在2000年至2011年的全国住院患者样本（NIS）数据中识别实体器官移植受者。采用连接点回归方法确定肺移植受者和其他实体器官移植受者平均总住院费用的变化时间点。比较通过连接点回归确定的两个肺移植受者时间队列的基线特征和资源利用情况，包括首次住院的总费用、每日费用、住院时间、出院处置、气管造口术以及体外膜肺氧合需求。
2005年肺移植受者的总住院费用出现显著增加点，与LAS的实施相对应，其他实体器官移植受者未出现这种情况。LAS实施后队列的总移植住院费用增加了40%（569,942美元[53,229美元]对407,489美元[28,360美元]），同时住院时间中位数、每日费用增加，出院处置情况（除回家外）增多。LAS实施后的受者移植后体外膜肺氧合的使用也更高（优势比，2.35；95%置信区间，1.56 - 3.55），气管造口术的发生率更高（优势比，1.52；95%置信区间，1.22 - 1.89）。
LAS的实施与肺移植首次住院期间资源利用的显著增加相关。
