Abstract
Background: The burgeoning influence of managed care in transplantation, coupled with a shrinking
health-care dollar, has placed most transplant programs under intense pressure to
cut costs. We undertook a retrospective cost-identification analysis to determine
what clinical variables influenced financial outcomes after orthotopic cadaver liver
transplants (OLTx). Methods: Fifty patients receiving 53 transplants between April 1995 and November 1996 were
reviewed. Clinical data were obtained from our institution's transplant database,
and total costs (not charges) for the transplant admission and the 6 months after
transplant were obtained with use of an activity-based cost accounting system (HBOC
Trendstar, Atlanta, Ga). Results: The average total cost of second transplants (n = 5) was $97,262 greater than for
first transplants (n = 48, P < .05). Patients transplanted initially as United Network for Organ Sharing (UNOS)
status 2 (n = 20) incurred average costs that were $51,762 higher than for patients
transplanted as UNOS status 3 (n = 28, P = .008). Patients with a major bacterial or fungal infection (n = 28) incurred average
costs $46,282 higher than recipients who were infection free (n = 22, P = .02). Multivariate analysis demonstrated that only length of stay, retransplantation,
and postoperative dialysis were significantly and independently correlated with costs
(r2 = .605). When the model was repeated with preoperative variables alone, only UNOS
status was significantly correlated with 6-month total costs (P = .006, r2 = .16). Conclusions: Length of stay is the most important determinant of costs after OLTx. Rational strategies
to design cost-effective protocols after OLTx will require further studies to truly
define the cost of various morbidities and outcomes after OLTx. (Surgery 1999;125:217-22.)
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Article info
Publication history
Accepted:
August 10,
1998
Footnotes
☆Reprint requests: James F. Whiting, MD, University of Cincinnati Department of Surgery, 231 Bethesda Ave, PO Box 67055, Cincinnati, OH 45267-0558.
Identification
Copyright
© 1999 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
