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Published on: November 7, 2020
Predictors of cost of liver transplantation in children: a single center study
J C Bucuvalas1, F C Ryckman, H Atherton
1Division of Gastroenterology and Nutrition, Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
Insights
An early discharge program for pediatric liver transplant patients significantly reduced hospital stay and costs by 29-36% without compromising clinical outcomes. This approach identifies key predictors for length of stay and associated expenses.
Area of Science:
- Pediatric surgery
- Transplantation medicine
- Health economics
Background:
- Orthotopic liver transplantation (OLT) costs necessitate strategies to reduce financial burden.
- Clinical outcomes must be maintained when implementing cost-saving interventions.
Purpose of the Study:
- To evaluate an early discharge intervention for pediatric OLT patients.
- To determine if reduced hospitalization length impacts clinical outcomes.
- To identify predictors of length of stay and hospitalization costs post-OLT.
Main Methods:
- A cohort of 47 pediatric OLT patients in an intervention group (transition to home program) was compared to 36 controls.
- Patients were discharged to a family living center upon meeting clinical and family educational criteria.
- Analysis included patients surviving at least 3 months post-OLT.
Main Results:
- The intervention group experienced a 29% decrease in mean length of stay and 36% reduction in total costs.
- Surgical costs were reduced by 34% in the intervention group.
- Predictors of length of stay and cost included organ type, height z score, race, hepatic artery thrombosis, early allograft rejection, and program participation.
Conclusions:
- An early discharge program, guided by specific criteria, effectively lowers hospitalization length and costs after pediatric OLT.
- This strategy can be implemented without negatively affecting clinical outcomes.
Objective:
Efforts to decrease the cost of orthotopic liver transplantation (OLT) must address the impact of specific interventions on clinical outcome. We hypothesized that an intervention designed to decrease the length of hospitalization would reduce costs without jeopardizing clinical outcome. We further sought to identify predictors of length of stay and cost for hospitalization after liver transplantation.
Methods:
The study group included 47 children who underwent OLT from September 1996 to April 1999, and the control group included 36 children who underwent OLT from March 1994 to August 1996. The intervention was a transition to home program in which patients were discharged to a family living center when they met established clinical criteria and their families met predefined educational goals. We analyzed patients who survived 3 months after OLT.
Results:
For the intervention group, the mean length of stay, total costs, and surgical costs were 29%, 36%, and 34% lower, respectively. Organ type, height z score, race, hepatic artery thrombosis, early allograft rejection, and participation in the transition to home program predicted length of stay and total costs.
Conclusion:
An early discharge program based on defined criteria can be used to decrease length of stay and cost after OLT without jeopardizing clinical outcome.
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