Independent Risk Factors and Economic Burden Associated With Delayed Extubation Following Pediatric Liver...

Area of Science:

• Pediatric Surgery
• Transplant Hepatology
• Critical Care Medicine

Background:

• Early extubation (EE) post-liver transplant (LT) in adults reduces complications and length of stay.
• EE feasibility and outcomes in pediatric LT patients, particularly those requiring prolonged mechanical ventilation, are not well-defined.
• Limited data exists on risk factors, consequences, and costs associated with delayed extubation (DE) in pediatric LT.

Purpose of the Study:

• To investigate predictive factors for EE and DE in pediatric LT recipients.
• To determine the associated hospital costs of EE versus DE in this population.
• To identify risk factors for DE to enable pre-operative planning.

Main Methods:

• Retrospective review of pediatric LT cases between 2011 and 2021.
• Analysis of 338 LT recipients, comparing outcomes and costs between EE (within 24 hours) and DE groups.
• Statistical analysis to identify independent predictors of DE and increased hospital costs.

Main Results:

• 73% of pediatric LT recipients achieved EE, while 27% experienced DE.
• Factors independently associated with DE included age < 1 year, biliary atresia diagnosis, abnormal pre-LT echocardiogram, and prior hospital admission.
• Hospital costs were approximately threefold higher in the DE group, with younger age and pre-LT hospitalization being significant cost drivers.

Conclusions:

• EE is achievable in pediatric LT and should be pursued.
• DE, although occurring in a minority of patients, is linked to substantially higher resource utilization and hospital costs.
• Pre-operative identification of children at risk for DE is crucial for resource allocation and optimizing care pathways.