Crawford Todd C, Magruder J Trent, Grimm Joshua C, Suarez-Pierre Alejandro, Patel Nishant, Sciortino Christopher M, Zehr Kenton J, Mandal Kaushik, Tedford Ryan J, Russell Stuart D, Conte John V, Higgins Robert S, Cameron Duke E, Whitman Glenn J
Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ann Thorac Surg. 2018 Jan;105(1):83-90. doi: 10.1016/j.athoracsur.2017.07.012. Epub 2017 Nov 1.
Prolonged hospital length of stay (PLOS) after heart transplantation increases cost and morbidity. To better inform care, we developed a risk score to identify patients at risk for PLOS after heart transplantation.
We queried the United Network for Organ Sharing Scientific Registry of Transplant Recipients database for adult patients who underwent isolated heart transplantation from 2003 to 2012. The population was randomly divided into a derivation cohort (80%) and a validation cohort (20%). The outcome of interest was PLOS, defined as a posttransplant hospital length of stay of more than 30 days. Associated univariables (p < 0.20) in the derivation cohort were included in a multivariable model, and a risk index was derived from the adjusted odds ratios of significant covariates.
During the study period, 16,723 patients underwent heart transplantation with an average PLOS of 19 ± 21 days, and 2,020 orthotopic heart transplant recipients (12%) had PLOS. Baseline characteristics were similar between the derivation and validation cohorts. Twenty-four recipient and nine donor variables, cold ischemic time, and center volume were tested as univariables. Seventeen covariates significantly affected PLOS and comprised the prolonged hospitalization after heart transplant risk score, which was stratified into three risk groups. The risk model was subsequently validated, and predicted rates of PLOS correlated well with observed rates (R = 0.79). Rates of PLOS in the validation cohort were 8.3%, 11%, and 22% for low, moderate, and high risk groups, respectively.
The risk of PLOS after heart transplantation can be determined at the time of transplant. The prolonged hospitalization after heart transplant score may lead to individualized postoperative management strategies to reduce duration of hospitalization for patients at high risk.
心脏移植后住院时间延长（PLOS）会增加成本和发病率。为了更好地指导治疗，我们开发了一种风险评分系统，以识别心脏移植后有PLOS风险的患者。
我们查询了器官共享联合网络移植受者科学登记数据库，获取2003年至2012年接受单纯心脏移植的成年患者信息。研究人群被随机分为推导队列（80%）和验证队列（20%）。感兴趣的结局是PLOS，定义为移植后住院时间超过30天。推导队列中相关的单变量（p<0.20）被纳入多变量模型，并从显著协变量的调整比值比中得出风险指数。
在研究期间，16723例患者接受了心脏移植，平均PLOS为19±21天，2020例原位心脏移植受者（12%）出现PLOS。推导队列和验证队列的基线特征相似。对24个受者变量、9个供者变量、冷缺血时间和中心容量进行了单变量测试。17个协变量对PLOS有显著影响，构成了心脏移植后延长住院风险评分，该评分分为三个风险组。随后对风险模型进行了验证，预测的PLOS发生率与观察到的发生率相关性良好（R=0.79）。验证队列中低、中、高风险组的PLOS发生率分别为8.3%、11%和22%。
心脏移植后PLOS的风险在移植时即可确定。心脏移植后延长住院评分可能会带来个体化的术后管理策略，以缩短高危患者的住院时间。
