S. Hirani1, Z. A. Sobani2, A. Jackson1, Z. Hirani1, E. Mortensen1, J. Arenas1, T. M. Pawlik4, O. Hyder3 1University Of Texas Southwestern Medical Center,Dallas, TX, USA 2Maimonides Medical Center,Surgery,Brooklyn, NY, USA 3Massachusetts General Hospital,Anesthesiology,Boston, MA, USA 4Johns Hopkins University School Of Medicine,Surgery,Baltimore, MD, USA
Introduction: The number of hepatic transplants performed in the US has been gradually increasing. This increase may be attributable to broadening indications, less stringent selection processes and expansion of services. However, as the procedure increases in frequency, comparable literature increases are not noticed, with an absence of large-scale studies reporting nationwide morbidity and mortality of the procedure.
Methods: In order to address this issue we sampled the Nationwide Inpatient Sample (NIS), a stratified random sample of US hospital discharges for patients undergoing hepatic transplants between the years 2000 and 2010. Outcomes variables considered in the study were in- hospital mortality and LOS, and the data was analyzed in 4 time periods 2000 to 2002; 2003 to 2005; 2006 to 2008; 2009 to 2010. Descriptive statistics and comparisons of patient characteristics and outcomes variables across time periods were performed.
Results:
During the 11-year period, 12,001 patients underwent liver transplantation. Cirrhosis without mention of alcohol was the most common indication accounting for nearly 40% of cases. The overall in-hospital mortality rate was 5.8%, however it declined from 8.5% in 2000-2002 to 0.2% in 2009-2010. Rural hospitals had a mortality of 20% while urban teaching hospitals had a mortality of 5.8% (p < 0.05).
Conclusion: Although there have been significant advances made in reducing perioperative mortality with liver transplants, the length of stay has not significantly changed over the span of 10 years. Further study is warranted to evaluate for 30 day mortality and long term outcomes. Also, there still exists great disparities depending on race, income, gender and geography. Potential reasons for these disparities, including limited access to healthcare and less experience with perioperative care of liver transplant patients, need to be further explored.