Variability in intensive care unit length of stay after liver transplant: Determinants and potential opportunities for improvement

Pita, Alejandro; Nguyen, Brian; Rios, Daisy; Maalouf, Nicolas; Lo, Mary; Genyk, Yuri; Sher, Linda; Cobb, J. Perren

doi:10.1016/j.jcrc.2019.01.003

Cited by 5 publications

(3 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hospital length of stay (LOS) is one measure that has been shown to impact postoperative outcomes such as infection risk and health care expenditures. [16][17][18] While many different predictors have been examined in single-site studies, 19 obesity is rarely implicated as a factor, and few national database studies have investigated this relationship. The aim of this study is to elucidate whether there is an association between recipient obesity and hospital LOS and mortality following liver transplant using a large national database.…”

mentioning

confidence: 99%

Is Obesity Associated With Better Liver Transplant Outcomes? A Retrospective Study of Hospital Length of Stay and Mortality Following Liver Transplantation

Du¹,

Danforth²,

Waterman³

et al. 2022

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

BACKGROUND:The rise in obesity in the United States, along with improvements in antiviral therapies, has led to an increase in the number of obese patients receiving liver transplants. Currently, obesity is a relative contraindication for liver transplant, although exact body mass index (BMI) limits continue to be debated. Studies conflict regarding outcomes in obese patients, while some argue that BMI should not be used as an exclusion criterion at all. Therefore, this retrospective study-utilizing a large national database-seeks to elucidate the association between recipient BMI and hospital length of stay and mortality following liver transplant. METHODS: A retrospective study was conducted using the United Network for Organ Sharing Standard Transplant Analysis and Research database. Fine-Gray competing risk regressions were used to explore the association between BMI and rate of discharge, which varies inversely with length of stay. In our model, subdistribution hazard ratio (SHR) represented the relative change in discharge rate compared to normal BMI, with in-hospital death was considered as a competing event for live discharge. Cox proportional hazard models were built to assess the association of BMI category on all-cause mortality after liver transplantation. Cluster-robust standard errors were used in all analyses to construct confidence intervals. RESULTS: Within the final sample (n = 47,038), overweight (≥25 and <30 kg/m 2 ) patients comprised the largest BMI group (34.7%). The competing risk regression model showed an association for increased length of stay among underweight (SHR = 0.82, 95% confidence interval [CI], 0.77-0.89; P < .001) and class 3 obesity patients (SHR = 0.88, 95% CI, 0.83-0.94; P < .001), while overweight (SHR = 1.05, 95% CI, 1.03-1.08; P < .001) and class 1 obesity (SHR = 1.04, 95% CI, 1.01-1.07; P = .01) were associated with decreased length of stay. When the sample excluded patients with low pretransplant functional status, however, length of stay was not significantly shorter for overweight and obesity class 1 patients. Cox proportional hazard models demonstrated increased survival among overweight, class 1 and class 2 obesity patients and decreased survival among underweight patients. CONCLUSIONS: Our results provide evidence that overweight and obesity class 1 are associated with decreased length of stay and mortality following liver transplant, while underweight and obesity class 3 are associated with prolonged length of stay. Pretransplant functional status may contribute to outcomes for overweight and class 1 obese patients, which necessitates continued investigation of the isolated impact of BMI in those who have had a liver transplant. (Anesth Analg 2022;135:118-27) KEY POINTS• Question: Is recipient obesity before liver transplant associated with prolonged hospital length of stay or increased mortality? • Findings: Overweight and obesity class 1 are associated with decreased length of stay and longterm mortality, while obesity class 3 and underweight are associate...

show abstract

mentioning

confidence: 99%

Is Obesity Associated With Better Liver Transplant Outcomes? A Retrospective Study of Hospital Length of Stay and Mortality Following Liver Transplantation

Du¹,

Danforth²,

Waterman³

et al. 2022

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

show abstract

“…Given the small sample size and variability of treatment in our cohort, more data are needed to determine if combination therapy is beneficial. Finally, both cohorts were infected with Enterococcus bacteremia following transplantation, and the data presented here may be reflective of a sicker population, as the length of stay in the ICU for both cohorts was longer than what has been reported on average for liver transplant recipients [ 48 ]. Further studies are needed to elucidate the effect of drug-resistant infections in liver transplantation.…”

Section: Discussionmentioning

confidence: 86%

Daptomycin-Resistant Enterococcus Bacteremia Is Associated With Prior Daptomycin Use and Increased Mortality After Liver Transplantation

Lee

Goldman

Haidar

et al. 2022

Open Forum Infectious Diseases

View full text Add to dashboard Cite

Background Risk factors for acquisition of vancomycin-resistant Enterococcus (VRE) include immunosuppression, antibiotic exposure, indwelling catheters, and manipulation of the gastrointestinal tract, all of which occur in liver transplant recipients. VRE infections are documented in liver transplantation (LT); however, only one single center study has assessed the impact daptomycin-resistant Enterococcus (DRE) in this patient population. Methods We conducted a retrospective multicenter cohort study comparing liver transplant recipients with either VRE or DRE bacteremia. The primary outcome was death within one year of transplantation. Multivariable logistic regression analyses were performed to calculate adjusted odds ratios for outcomes of interest. Results We identified 139 cases of Enterococcus bacteremia following LT, of which 78% were VRE and 22% were DRE. When adjusted for total ICU days in the first transplant year, liver-kidney transplantation, and calcineurin inhibitor use, patients with DRE bacteremia were 2.65 times more likely to die within one year of transplantation (aOR 2.648 [1.025-6.840], p = 0.044). Prior daptomycin exposure was found to be an independent predictor of DRE bacteremia (aOR 30.62 (10.087-92.955), p <0.001). Conclusions In this multicenter study of LT recipients with Enterococcus bacteremia, DRE bacteremia was associated with higher 1-year mortality rates when compared to VRE bacteremia. Our data provide strong support for dedicated infection prevention and antimicrobial stewardship efforts for transplant patients. Further research is needed to support the development of better antibiotics for DRE and practical guidance focusing on identification and prevention of colonization and subsequent infection in liver transplant recipients at high risk for DRE bacteremia.

show abstract

“…2,3 There is evidence that improving communication and setting clear goals for postoperative critical care management reduces the length of hospital stay with no adverse impact on patient outcome. 4,5 Furthermore, protocolized pathways have previously been shown to reduce both intensive care unit (ICU) and hospital length of stay without affecting postoperative complications or readmission rates. 6,7 Multiple studies have explored the variables associated with patients that are amenable to early extubation and fast-track (FT) following liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

Predicting Early Extubation After Liver Transplantation: External Validation and Improved Generalizability of a Proposed Fast-track Score

et al. 2021

View full text Add to dashboard Cite

show abstract

Variability in intensive care unit length of stay after liver transplant: Determinants and potential opportunities for improvement

Cited by 5 publications

References 22 publications

Is Obesity Associated With Better Liver Transplant Outcomes? A Retrospective Study of Hospital Length of Stay and Mortality Following Liver Transplantation

Is Obesity Associated With Better Liver Transplant Outcomes? A Retrospective Study of Hospital Length of Stay and Mortality Following Liver Transplantation

Daptomycin-Resistant Enterococcus Bacteremia Is Associated With Prior Daptomycin Use and Increased Mortality After Liver Transplantation

Predicting Early Extubation After Liver Transplantation: External Validation and Improved Generalizability of a Proposed Fast-track Score

Contact Info

Product

Resources

About