Hawkins Robert B, Scott Erik, Mehaffey J Hunter, Strobel Raymond J, Speir Alan, Quader Mohammed, Teman Nicholas R, Yarboro Leora T
Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va.
JTCVS Open. 2022 Nov 4;13:218-231. doi: 10.1016/j.xjon.2022.11.002. eCollection 2023 Mar.
The 2018 change in the heart transplant allocation system resulted in greater use of temporary mechanical circulatory support. We hypothesized that the allocation change has increased hospital resource utilization, including length of stay and cost.
All heart transplant patients within a regional Society of Thoracic Surgeons database were included (2012-2020). Patients were stratified before and after the transplant allocation changes into early (January 2012-September 2018) and late eras (November 2018-June 2020). Costs were adjusted for inflation and presented in 2020 dollars.
Of 535 heart transplants, there were 410 early and 125 late era patients. Baseline characteristics were similar, except for greater lung and valvular disease in the late era. Fewer patients in the late era were bridged with durable left ventricular assist devices (69% vs 31%; < .0001), biventricular devices (5% vs 1%; = .047), and more with temporary mechanical circulatory support (4% vs 46%; < .0001). There was no difference in early mortality (6% vs 4%; = .33) or major morbidity (57% vs 61%; = .40). Length of stay was longer preoperatively (1 vs 9 days; < .0001), but not different postoperatively. There was no difference in median total hospital cost ($132,465 vs $128,996; = .15), although there was high variability. On multivariable regression, preoperative extracorporeal membrane oxygenation utilization was the main driver of resource utilization.
The new heart transplant allocation system has resulted in different bridging techniques, with greater reliance on temporary mechanical circulatory support. Although this is associated with an increase in preoperative length of stay, it did not translate into increased hospital cost.
2018年心脏移植分配系统的改变导致临时机械循环支持的使用增加。我们假设分配的改变增加了医院资源的利用，包括住院时间和成本。
纳入区域胸外科医师协会数据库中的所有心脏移植患者（2012 - 2020年）。在移植分配改变前后，将患者分为早期（2012年1月 - 2018年9月）和晚期（2018年11月 - 2020年6月）。成本进行了通货膨胀调整，并以2020年美元表示。
在535例心脏移植中，早期有410例患者，晚期有125例患者。除晚期肺部和瓣膜疾病较多外，基线特征相似。晚期使用耐用左心室辅助装置进行过渡的患者较少（69%对31%；P <.0001），双心室装置（5%对1%；P = 0.047），而使用临时机械循环支持的患者更多（4%对46%；P <.0001）。早期死亡率（6%对4%；P = 0.33）或主要并发症发生率（57%对61%；P = 0.40）无差异。术前住院时间较长（1天对9天；P <.0001），但术后无差异。总住院费用中位数无差异（132,465美元对128,996美元；P = 0.15），尽管存在高度变异性。在多变量回归分析中，术前体外膜肺氧合的使用是资源利用的主要驱动因素。
新的心脏移植分配系统导致了不同的过渡技术，更多地依赖临时机械循环支持。虽然这与术前住院时间增加有关，但并未转化为医院成本的增加。
