Brown R S, Ascher N L, Lake J R, Emond J C, Bacchetti P, Randall H B, Roberts J P
Department of Medicine, University of North Carolina at Chapel Hill, USA.
Arch Surg. 1997 Oct;132(10):1098-103. doi: 10.1001/archsurg.1997.01430340052008.
To evaluate the impact of surgical complications on length of stay and hospital charges after liver transplantation.
A retrospective economic evaluation of the outcomes during initial hospitalization after liver transplantation.
University hospital treating referred patients.
The study population was 109 patients undergoing 111 liver transplantations during fiscal year 1993.
Hospital charges and length of stay during the initial hospitalization after liver transplantation. Multivariate regression methods were used to analyze the impact of surgical complications on costs.
Of the 111 transplantations, 30 (27%) had a surgical complication that required a return to the operating room during the initial hospitalization. The effect of a surgical complication was to increase the mean hospital charges (excluding physician charges) from $150,092 to $347,728 (difference of mean, $197,636; confidence interval of difference, $114,153 to $319,326). The median length of stay was 16 days for patients without complications and 45 days for those with complications. Univariate and multivariate models suggested that surgical complications had the greatest effect on length of stay and hospital charges among the factors studied. Complications tended to occur more frequently among patients with United Network for Organ Sharing (UNOS) status 1 (42% vs 22%), but this did not reach statistical significance (P = .09).
Surgical complications after liver transplantation have a marked impact on the cost of the procedure. The magnitude of this effect is greater than that of UNOS status, presence of rejection, or other demographic or clinical factors studied. Complications tend to occur in the most ill patients. Identifying strategies to reduce the risk of complications, particularly in patients with UNOS status 1, likely can reduce the cost of transplantation.
评估肝移植术后手术并发症对住院时间和住院费用的影响。
对肝移植术后首次住院期间的结局进行回顾性经济评估。
治疗转诊患者的大学医院。
研究人群为1993财年接受111例肝移植手术的109例患者。
肝移植术后首次住院期间的住院费用和住院时间。采用多变量回归方法分析手术并发症对费用的影响。
在111例移植手术中，30例（27%）出现手术并发症，需要在首次住院期间返回手术室。手术并发症的影响是使平均住院费用（不包括医生费用）从150,092美元增加到347,728美元（平均差异为197,636美元；差异的置信区间为114,153美元至319,326美元）。无并发症患者的中位住院时间为16天，有并发症患者为45天。单变量和多变量模型表明，在所研究的因素中，手术并发症对住院时间和住院费用的影响最大。器官共享联合网络（UNOS）1级状态的患者并发症发生率往往更高（42%对22%），但未达到统计学意义（P = 0.09）。
肝移植术后的手术并发症对手术费用有显著影响。这种影响的程度大于UNOS状态、排斥反应的存在或所研究的其他人口统计学或临床因素。并发症往往发生在病情最严重的患者中。确定降低并发症风险的策略，特别是在UNOS 1级状态的患者中，可能会降低移植成本。
