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Hospital-Acquired Conditions after Liver Transplantation
Zhobin Moghadamyeghaneh1, Antonio Masi1, Michael Silver1
1From the Departments of *Surgery; †Medicine; and ‡Statics, State University of New York, Downstate Medical Center, Brooklyn, New York.
Insights
Hospital-acquired conditions (HACs) are common after liver transplants, with vascular catheter infections being most frequent. Patient factors, not just hospital performance, significantly influence HAC development, questioning their reliability for evaluating hospitals.
Area of Science:
- Medical research
- Health services research
- Patient safety
Background:
- Hospital-acquired conditions (HACs) are key metrics for hospital performance evaluation.
- Patient comorbidities can significantly impact the development of HACs.
- Liver transplantation patients may be at a higher risk for HACs due to complex health conditions.
Purpose of the Study:
- To investigate the incidence and types of HACs in patients undergoing liver transplantation.
- To identify patient-specific risk factors associated with HAC development in this population.
- To assess the reliability of HACs as a performance measure for hospitals performing liver transplants.
Main Methods:
- Utilized the National Inpatient Sample database for data from 2002-2014.
- Included 13,816 patients who underwent liver transplantation.
- Employed multivariate analysis to determine risk factors for HACs.
Main Results:
- A total of 330 (2.4%) liver transplant patients developed HACs.
- The most common HACs were vascular catheter-associated infections (1.6%), falls and trauma (0.5%), and catheter-associated UTIs (0.2%).
- Significant risk factors included severe liver dysfunction (extreme/major loss function), hepatopulmonary syndrome, portal hypertension, and longer pre-transplant hospital stays.
Conclusions:
- The HAC rate in liver transplant patients is substantially higher than in general GI procedures.
- Multiple patient-related factors are strongly associated with HACs, suggesting HACs may not be a sole reliable indicator of hospital performance.
- Vascular catheter-associated infection is the predominant HAC following liver transplantation.
Abstract:
Hospital-acquired conditions (HACs) are used to define hospital performance measures. Patient comorbidity may influence HAC development. The National Inpatient Sample database was used to investigate HACs for the patients who underwent liver transplantation. Multivariate analysis was used to identify HAC risk factors. We found a total of 13,816 patients who underwent liver transplantation during 2002-2014. Of these, 330 (2.4%) had a report of HACs. Most frequent HACs were vascular catheter-associated infection [220 (1.6%)], falls and trauma [66 (0.5%), catheter-associated UTI [24 (0.2%)], and pressure ulcer stage III/IV [22 (0.2%)]. Factors correlating with HACs included extreme loss function (AOR: 52.13, P < 0.01) and major loss function (AOR: 8.11, P = 0.04), hepatopulmonary syndrome (AOR: 3.39, P = 0.02), portal hypertension (AOR: 1.49, P = 0.02), and hospitalization length of stay before transplant (AOR: 1.01, P < 0.01). The rate of HACs for liver transplantation is three times higher than the reported overall rate of HACs for GI procedures. Multiple patient factors are associated with HACs, and HACs may not be a reliable measure to evaluate hospital performance. Vascular catheter-associated infection is the most common HAC after liver transplantation.
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