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Hospital Utilization of Nationally Shared Liver Allografts from 2009-2012

Ertel, Audrey E
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1428065067

Abstract Details

2015, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Objectives: Due to the current geographic disparities in liver allocation the Organ procurement and transplantation network has developed and proposed a regional redistricting policy which includes two potential redistricting plans, that would reduce the number of UNOS regions from the current 11 regions to 8 or 4 much larger regions. The measure of potential success of these proposed redistricting plans have been based upon regional median MELD scores and reductions in waitlist mortality. While these are important measures, no research has been done to assess the affects of such a policy change on recipient outcomes. We investigated the potential implications of this policy change on perioperative outcomes and resource utilization following liver transplantation (LT). Methods: Analysis was based on 12,282 deceased donor liver transplants performed between 2007-2012 using the Scientific Registry of Transplant Recipients linked to the University HealthSystem Consortium database. Univariate and multivariate analysis were used to determine how patient characteristics and hospital outcomes were associated with national sharing. Results: Compared to locally distributed livers, nationally shared livers have a donor risk index >1.8 (64.3% vs. 11.6%), are more likely to be classified as expanded criteria donors (44.6% vs. 24.8%), and are transplanted into healthier recipients. Nationally shared LTs were more likely to be performed at high volume centers (49.1% vs. 30.6%), resulted in longer overall length of stay (11 vs. 9 days), and higher in-hospital mortality (6.6% vs. 3.3%). In addition, nationally shared allografts were independent predictors of in-hospital mortality (OR 1.64, 95% CI 1.13-2.39) and length of stay (OR 1.12, 95% CI 1.02-1.21). Discussion: These data suggest that increased national sharing of livers will likely result inferior patient outcomes, such as increased in-hospital mortality, length of stay, readmission rate, and increased hospital resource utilization.
Erin Nicole Haynes, Dr.P.H. (Committee Chair)
Shimul Shah, M.D. (Committee Member)
Koffi Wima, M.S. (Committee Member)
21 p.
Surgery
Liver Transplantation; Liver Sharing; Outcomes; UNOS

Recommended Citations

Citations

  • Ertel, A. E. (2015). Hospital Utilization of Nationally Shared Liver Allografts from 2009-2012 [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1428065067

    APA Style (7th edition)

  • Ertel, Audrey. Hospital Utilization of Nationally Shared Liver Allografts from 2009-2012. 2015. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1428065067.

    MLA Style (8th edition)

  • Ertel, Audrey. "Hospital Utilization of Nationally Shared Liver Allografts from 2009-2012." Master's thesis, University of Cincinnati, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1428065067

    Chicago Manual of Style (17th edition)

ucin1428065067
414
© 2015, all rights reserved.
This open access ETD is published by University of Cincinnati and OhioLINK.