Abstract
Background: Severe geographic inequities in liver transplantation have persisted for years. Previous investigators have demonstrated 90-day transplant rates varying from 14% to 82% and death rates varying from 18% to 86%. The aim of this analysis was to utilize a robust multivariate analysis to investigate whether geographic inequities affected the length of stay after liver transplantation. Methods: We conducted a unique Kaplan-Meier analysis with the event being discharge from the hospital and length of stay as the time to the event, using a cohort of 66 674 recipients listed in the UNOS database from 2002 to 2016. Multivariate Cox regression using 43 covariates was used for time-to-event analysis. Results: Region 9 (0.82; CI 0.79-0.85), Region 2 (0.85; CI 0.83-0.88), and Region 10 (0.96; CI 0.93-0.99) were statistically significant factors for prolonged hospital stay. The following covariates were the most significant factors for prolonged hospital stay: serum sodium >150 mEq/L (0.70; CI 0.62-0.78), ICU admission (0.77; CI 0.74-0.80), hospital admission (0.81; 0.79-0.83), region 9 (0.82; CI 0.79-0.85), and ventilator dependence (0.82; CI 0.76-0.88). Conclusion: In this analysis, we demonstrate regional disparities in hospital length of stay that are significant in robust multivariable Cox regression analysis. We hope the transplant community will take immediate measures to correct geographic inequities.
| Original language | English (US) |
|---|---|
| Article number | e13336 |
| Journal | Clinical Transplantation |
| Volume | 32 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 1 2018 |
| Externally published | Yes |
Fingerprint
Keywords
- quality of care/care delivery
- registry/registry analysis
- risk assessment/risk stratification
- United Network for Organ Sharing
ASJC Scopus subject areas
- Transplantation
Cite this
Adding to the mounting evidence for geographic inequity in liver transplantation : Hospital length of stay. / Kueht, Michael; Goss, John A.; Rana, Abbas.
In: Clinical Transplantation, Vol. 32, No. 9, e13336, 01.09.2018.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Adding to the mounting evidence for geographic inequity in liver transplantation
T2 - Hospital length of stay
AU - Kueht, Michael
AU - Goss, John A.
AU - Rana, Abbas
PY - 2018/9/1
Y1 - 2018/9/1
N2 - Background: Severe geographic inequities in liver transplantation have persisted for years. Previous investigators have demonstrated 90-day transplant rates varying from 14% to 82% and death rates varying from 18% to 86%. The aim of this analysis was to utilize a robust multivariate analysis to investigate whether geographic inequities affected the length of stay after liver transplantation. Methods: We conducted a unique Kaplan-Meier analysis with the event being discharge from the hospital and length of stay as the time to the event, using a cohort of 66 674 recipients listed in the UNOS database from 2002 to 2016. Multivariate Cox regression using 43 covariates was used for time-to-event analysis. Results: Region 9 (0.82; CI 0.79-0.85), Region 2 (0.85; CI 0.83-0.88), and Region 10 (0.96; CI 0.93-0.99) were statistically significant factors for prolonged hospital stay. The following covariates were the most significant factors for prolonged hospital stay: serum sodium >150 mEq/L (0.70; CI 0.62-0.78), ICU admission (0.77; CI 0.74-0.80), hospital admission (0.81; 0.79-0.83), region 9 (0.82; CI 0.79-0.85), and ventilator dependence (0.82; CI 0.76-0.88). Conclusion: In this analysis, we demonstrate regional disparities in hospital length of stay that are significant in robust multivariable Cox regression analysis. We hope the transplant community will take immediate measures to correct geographic inequities.
AB - Background: Severe geographic inequities in liver transplantation have persisted for years. Previous investigators have demonstrated 90-day transplant rates varying from 14% to 82% and death rates varying from 18% to 86%. The aim of this analysis was to utilize a robust multivariate analysis to investigate whether geographic inequities affected the length of stay after liver transplantation. Methods: We conducted a unique Kaplan-Meier analysis with the event being discharge from the hospital and length of stay as the time to the event, using a cohort of 66 674 recipients listed in the UNOS database from 2002 to 2016. Multivariate Cox regression using 43 covariates was used for time-to-event analysis. Results: Region 9 (0.82; CI 0.79-0.85), Region 2 (0.85; CI 0.83-0.88), and Region 10 (0.96; CI 0.93-0.99) were statistically significant factors for prolonged hospital stay. The following covariates were the most significant factors for prolonged hospital stay: serum sodium >150 mEq/L (0.70; CI 0.62-0.78), ICU admission (0.77; CI 0.74-0.80), hospital admission (0.81; 0.79-0.83), region 9 (0.82; CI 0.79-0.85), and ventilator dependence (0.82; CI 0.76-0.88). Conclusion: In this analysis, we demonstrate regional disparities in hospital length of stay that are significant in robust multivariable Cox regression analysis. We hope the transplant community will take immediate measures to correct geographic inequities.
KW - quality of care/care delivery
KW - registry/registry analysis
KW - risk assessment/risk stratification
KW - United Network for Organ Sharing
UR - http://www.scopus.com/inward/record.url?scp=85050682285&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85050682285&partnerID=8YFLogxK
U2 - 10.1111/ctr.13336
DO - 10.1111/ctr.13336
M3 - Article
C2 - 29947035
AN - SCOPUS:85050682285
VL - 32
JO - Clinical Transplantation
JF - Clinical Transplantation
SN - 0902-0063
IS - 9
M1 - e13336
ER -