Department of Surgery, University of Louisville, Louisville, KY, USA.
Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA.
Clin Transplant. 2018 Apr;32(4):e13209. doi: 10.1111/ctr.13209. Epub 2018 Feb 14.
Perioperative complications impose both a clinical and financial burden on patients and the healthcare system. This study sought to identify the frequency and economic impact of complications following orthotopic liver transplantation (OLT).
The Premier Perspective Hospital Database was queried for patients undergoing OLT between 2008 and 2015. Complications were identified by ICD-9 code and grouped by complication type. Complication frequency as well as impact on clinical and economic outcomes was calculated. Complication frequency and effect on cost were combined to determine the annual impact of each complication type on perioperative OLT cost.
Among 2747 OLT patients, the most common groups of complications following OLT were pulmonary, bleeding, and infectious. The complications with the greatest average effect on treatment-related costs were infectious, neurologic, deep vein thrombosis/pulmonary embolus, and hepatic arterial thrombosis. Infectious, pulmonary, and bleeding complications had the greatest annual effect on perioperative OLT cost.
Efforts focused on preventing coagulopathic bleeding, improving post-operative pulmonary toilet, and minimizing sources of infection can help improve the cost-effectiveness of OLT. Additionally, the combination of these cost data and systematized protocols can help insurers construct bundled payments for OLT that more accurately reflect the cost of perioperative transplant care.
围手术期并发症不仅给患者和医疗保健系统带来临床和经济负担。本研究旨在确定原位肝移植（OLT）后并发症的频率和经济影响。
通过 ICD-9 代码查询 2008 年至 2015 年期间接受 OLT 的患者的 Premier Perspective 医院数据库。根据并发症类型对并发症进行分组。计算并发症的发生频率以及对临床和经济结果的影响。将并发症的发生频率及其对成本的影响相结合，以确定每种并发症类型对围手术期 OLT 成本的年度影响。
在 2747 例 OLT 患者中，OLT 后最常见的并发症组为肺部、出血和感染。对治疗相关费用影响最大的并发症为感染、神经、深静脉血栓形成/肺栓塞和肝动脉血栓形成。感染、肺部和出血并发症对围手术期 OLT 成本的年度影响最大。
努力预防出血性凝血功能障碍、改善术后肺部通气以及尽量减少感染源有助于提高 OLT 的成本效益。此外，这些成本数据和系统协议的组合可以帮助保险公司为 OLT 构建捆绑支付，更准确地反映围手术期移植护理的成本。
