TY - JOUR
T1 - National assessment of early biliary complications after liver transplantation
T2 - Economic implications
AU - Axelrod, David A.
AU - Dzebisashvilli, Nino
AU - Lentine, Krista L.
AU - Xiao, Huiling
AU - Schnitzler, Mark
AU - Tuttle-Newhall, Janet E.
AU - Segev, Dorry L.
N1 - Publisher Copyright:
© 2014 Lippincott Williams & Wilkins.
PY - 2014/12/15
Y1 - 2014/12/15
N2 - Background. Despite improvement in surgical technique and medical management of liver transplant recipients, biliary complications remain a frequent cause of posttransplant morbidity and graft loss. Biliary complications require potentially expensive interventions including radiologic procedures and surgical revisions.Methods. A national data set linking transplant registry and Medicare claims data for 12,803 liver transplant recipients was developed to capture information on complications, treatments, and associated direct medical costs up to 3 years after transplantation.Results. Biliary complications were more common in recipients of donation after cardiac death compared to donation after brain death allografts (23% vs. 19% P<0.001). Among donation after brain death recipients, biliary complications were associated with $54,699 (95% confidence interval [CI], $ 49,102 to $ 60,295) of incremental spending in the first year after transplantation and $ 7,327 in years 2 and 3 (95% CI, $ 4,419Y$ 10,236). Biliary complications in donation after cardiac death recipients independently increased spending by $ 94,093 (95% CI, $ 64,643Y$ 124,542) in the first year and $ 12,012 (95% CI, $ j1,991 to $ 26,016) in years 2 and 3.Conclusion. This national study of biliary complications demonstrates the significant economic impact of this common perioperative complication and suggests a potential target for quality of care improvements.
AB - Background. Despite improvement in surgical technique and medical management of liver transplant recipients, biliary complications remain a frequent cause of posttransplant morbidity and graft loss. Biliary complications require potentially expensive interventions including radiologic procedures and surgical revisions.Methods. A national data set linking transplant registry and Medicare claims data for 12,803 liver transplant recipients was developed to capture information on complications, treatments, and associated direct medical costs up to 3 years after transplantation.Results. Biliary complications were more common in recipients of donation after cardiac death compared to donation after brain death allografts (23% vs. 19% P<0.001). Among donation after brain death recipients, biliary complications were associated with $54,699 (95% confidence interval [CI], $ 49,102 to $ 60,295) of incremental spending in the first year after transplantation and $ 7,327 in years 2 and 3 (95% CI, $ 4,419Y$ 10,236). Biliary complications in donation after cardiac death recipients independently increased spending by $ 94,093 (95% CI, $ 64,643Y$ 124,542) in the first year and $ 12,012 (95% CI, $ j1,991 to $ 26,016) in years 2 and 3.Conclusion. This national study of biliary complications demonstrates the significant economic impact of this common perioperative complication and suggests a potential target for quality of care improvements.
KW - Biliary complications
KW - Cost
KW - Donation after cardiac death
KW - Economic analysis
KW - Graft failure
KW - Liver transplantation
KW - Outcomes research
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U2 - 10.1097/TP.0000000000000197
DO - 10.1097/TP.0000000000000197
M3 - Article
C2 - 25119126
AN - SCOPUS:84917686086
SN - 0041-1337
VL - 98
SP - 1226
EP - 1235
JO - Transplantation
JF - Transplantation
IS - 11
ER -