Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA, USA.
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.
Am J Transplant. 2018 May;18(5):1197-1205. doi: 10.1111/ajt.14539. Epub 2017 Nov 17.
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.
肝移植（LT）前后的医疗保健利用情况及其与中心特征的关系尚不完全清楚。这是一项使用 Vizient 住院索赔数据与美国器官共享联合网络（UNOS）数据库相关联的 2002 年至 2013 年间 34402 例成人 LT 的回顾性队列研究。多变量混合效应线性回归模型评估了 LT 前 90 天住院与 LT 后 1 年生存天数和出院天数（DAOH）之间的关联。在 LT 出院时存活的患者中，有 24.7%在第一年中有≥30 天的住院时间。LT 前 90 天的住院与 DAOH 呈负相关（β=-3.4 DAOH/周 LT 前住院；P=0.002）。LT 第一年中≥30%的肝移植受者住院时间≥30 天的中心通常规模较小，或接受风险较高的受者进行移植（终末期肝病模型[MELD]评分≥35，LT 前住院或通气）。总之，LT 前的住院情况可预测 LT 后 1 年的住院情况，与患者 MELD 评分无关，而特定中心的 LT 后医疗保健利用情况与某些中心行为和选择实践有关。
