Readmission to the intensive care unit after liver transplantation

Marlon F. Levy, Lonnie Greene, Michael A E Ramsay, Linda W. Jennings, Kirsten J. Ramsay, Jin Meng, H. A. Tillmann Hein, Robert M. Goldstein, Bo S. Husberg, Thomas A. Gonwa, Goran B. Klintmalm

Research output: Contribution to journalArticle

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Abstract

Objective: We undertook this study to understand the factors at our transplant center that contribute to patients' return to the ICU after their liver transplant and their initial discharge from that unit. Patients who, after liver transplantation, fail discharge from the Intensive Care Unit (ICU) and must be readmitted to that unit may well utilize many more resources than those patients who are well enough to stay out of the ICU. Design: A retrospective review of a prospectively maintained liver transplant research database followed by a retrospective review of (a subgroup) patient charts and contemporaneous controls. Setting: A large metropolitan tertiary care center and adult liver transplant center. Patients: A total of 1,197 consecutive adult patients who underwent their initial liver transplantation from 1984 to 1996. Intervention: Readmission to the intensive care unit after adult liver transplantation and discharge from that unit. Main Results: Only recipient age, pretransplant synthetic function labs (protime and albumin), bilirubin levels, and intraoperative blood product requirements could be statistically linked to the group requiring ICU readmission. The primary etiology for ICU readmission was cardiopulmonary deterioration. Readmission was associated with significantly lower patient and graft survivals. A detailed review of 23 patients transplanted from October 1994 to June 1996 was made, with special emphasis on cardiopulmonary status (hemodynamics, respiratory variables, and chest radiograph findings). This subgroup was compared with 30 temporally matched controls who were not readmitted to the ICU. Intravascular fluid overload and lower inspiratory capacity were significant factors related to ICU readmission. Readmitted patients had a longer hospitalization with higher hospital charges than the control group. Conclusions: We conclude that the most important means of preventing ICU readmission in liver transplantation patients is to optimize cardiopulmonary function and status. Close monitoring of fluid balance to avoid hypervolemia is essential. Readmitted patients have a greater resource utilization and have lower survival rates.

Original languageEnglish (US)
Pages (from-to)18-24
Number of pages7
JournalCritical Care Medicine
Volume29
Issue number1
StatePublished - 2001
Externally publishedYes

Fingerprint

Liver Transplantation
Intensive Care Units
Transplants
Liver
Inspiratory Capacity
Hospital Charges
Water-Electrolyte Balance
Graft Survival
Bilirubin
Tertiary Care Centers
Albumins
Hospitalization
Thorax
Survival Rate
Hemodynamics
Databases
Control Groups

Keywords

  • Costs
  • Intensive care unit readmission
  • Liver transplantation
  • Pulmonary function
  • Resource utilization

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Levy, M. F., Greene, L., Ramsay, M. A. E., Jennings, L. W., Ramsay, K. J., Meng, J., ... Klintmalm, G. B. (2001). Readmission to the intensive care unit after liver transplantation. Critical Care Medicine, 29(1), 18-24.

Readmission to the intensive care unit after liver transplantation. / Levy, Marlon F.; Greene, Lonnie; Ramsay, Michael A E; Jennings, Linda W.; Ramsay, Kirsten J.; Meng, Jin; Tillmann Hein, H. A.; Goldstein, Robert M.; Husberg, Bo S.; Gonwa, Thomas A.; Klintmalm, Goran B.

In: Critical Care Medicine, Vol. 29, No. 1, 2001, p. 18-24.

Research output: Contribution to journalArticle

Levy, MF, Greene, L, Ramsay, MAE, Jennings, LW, Ramsay, KJ, Meng, J, Tillmann Hein, HA, Goldstein, RM, Husberg, BS, Gonwa, TA & Klintmalm, GB 2001, 'Readmission to the intensive care unit after liver transplantation', Critical Care Medicine, vol. 29, no. 1, pp. 18-24.
Levy MF, Greene L, Ramsay MAE, Jennings LW, Ramsay KJ, Meng J et al. Readmission to the intensive care unit after liver transplantation. Critical Care Medicine. 2001;29(1):18-24.
Levy, Marlon F. ; Greene, Lonnie ; Ramsay, Michael A E ; Jennings, Linda W. ; Ramsay, Kirsten J. ; Meng, Jin ; Tillmann Hein, H. A. ; Goldstein, Robert M. ; Husberg, Bo S. ; Gonwa, Thomas A. ; Klintmalm, Goran B. / Readmission to the intensive care unit after liver transplantation. In: Critical Care Medicine. 2001 ; Vol. 29, No. 1. pp. 18-24.
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AU - Levy, Marlon F.

AU - Greene, Lonnie

AU - Ramsay, Michael A E

AU - Jennings, Linda W.

AU - Ramsay, Kirsten J.

AU - Meng, Jin

AU - Tillmann Hein, H. A.

AU - Goldstein, Robert M.

AU - Husberg, Bo S.

AU - Gonwa, Thomas A.

AU - Klintmalm, Goran B.

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N2 - Objective: We undertook this study to understand the factors at our transplant center that contribute to patients' return to the ICU after their liver transplant and their initial discharge from that unit. Patients who, after liver transplantation, fail discharge from the Intensive Care Unit (ICU) and must be readmitted to that unit may well utilize many more resources than those patients who are well enough to stay out of the ICU. Design: A retrospective review of a prospectively maintained liver transplant research database followed by a retrospective review of (a subgroup) patient charts and contemporaneous controls. Setting: A large metropolitan tertiary care center and adult liver transplant center. Patients: A total of 1,197 consecutive adult patients who underwent their initial liver transplantation from 1984 to 1996. Intervention: Readmission to the intensive care unit after adult liver transplantation and discharge from that unit. Main Results: Only recipient age, pretransplant synthetic function labs (protime and albumin), bilirubin levels, and intraoperative blood product requirements could be statistically linked to the group requiring ICU readmission. The primary etiology for ICU readmission was cardiopulmonary deterioration. Readmission was associated with significantly lower patient and graft survivals. A detailed review of 23 patients transplanted from October 1994 to June 1996 was made, with special emphasis on cardiopulmonary status (hemodynamics, respiratory variables, and chest radiograph findings). This subgroup was compared with 30 temporally matched controls who were not readmitted to the ICU. Intravascular fluid overload and lower inspiratory capacity were significant factors related to ICU readmission. Readmitted patients had a longer hospitalization with higher hospital charges than the control group. Conclusions: We conclude that the most important means of preventing ICU readmission in liver transplantation patients is to optimize cardiopulmonary function and status. Close monitoring of fluid balance to avoid hypervolemia is essential. Readmitted patients have a greater resource utilization and have lower survival rates.

AB - Objective: We undertook this study to understand the factors at our transplant center that contribute to patients' return to the ICU after their liver transplant and their initial discharge from that unit. Patients who, after liver transplantation, fail discharge from the Intensive Care Unit (ICU) and must be readmitted to that unit may well utilize many more resources than those patients who are well enough to stay out of the ICU. Design: A retrospective review of a prospectively maintained liver transplant research database followed by a retrospective review of (a subgroup) patient charts and contemporaneous controls. Setting: A large metropolitan tertiary care center and adult liver transplant center. Patients: A total of 1,197 consecutive adult patients who underwent their initial liver transplantation from 1984 to 1996. Intervention: Readmission to the intensive care unit after adult liver transplantation and discharge from that unit. Main Results: Only recipient age, pretransplant synthetic function labs (protime and albumin), bilirubin levels, and intraoperative blood product requirements could be statistically linked to the group requiring ICU readmission. The primary etiology for ICU readmission was cardiopulmonary deterioration. Readmission was associated with significantly lower patient and graft survivals. A detailed review of 23 patients transplanted from October 1994 to June 1996 was made, with special emphasis on cardiopulmonary status (hemodynamics, respiratory variables, and chest radiograph findings). This subgroup was compared with 30 temporally matched controls who were not readmitted to the ICU. Intravascular fluid overload and lower inspiratory capacity were significant factors related to ICU readmission. Readmitted patients had a longer hospitalization with higher hospital charges than the control group. Conclusions: We conclude that the most important means of preventing ICU readmission in liver transplantation patients is to optimize cardiopulmonary function and status. Close monitoring of fluid balance to avoid hypervolemia is essential. Readmitted patients have a greater resource utilization and have lower survival rates.

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