Resource utilization in liver transplantation: Effects of patient characteristics and clinical practice

Jonathan Showstack, Patricia P. Katz, John R. Lake, Robert S. Brown, R. Adams Dudley, Steven Belle, Russell H. Wiesner, Rowen K. Zetterman, James Everhart

Research output: Contribution to journalArticle

170 Citations (Scopus)

Abstract

Context Liver transplantation is among the most costly of medical services, yet few studies have addressed the relationship between the resources utilized for this procedure and specific patient characteristics and clinical practices. Objective To assess the association of pretransplant patient characteristics and clinical practices with hospital resource utilization. Design Prospective cohort of patients who received liver transplants between January 1991 and July 1994. Setting University of California, San Francisco; Mayo Clinic, Rochester, Minn; and the University of Nebraska, Omaha. Patients Seven hundred eleven patients who received single-organ liver transplants, were at least 16 years old, and had nonfulminant liver disease. Main Outcome Measure Standardized resource utilization derived from a database created by matching all services to a single price list. Results Higher adjusted resource utilization was associated with donor age of 60 years or older (28% [$53 813] greater mean resource utilization; P= .005); recipient age of 60 years or older (17% [$32 795]; P = .01); alcoholic liver disease (26% [$49 596]; P = .002); Child- Pugh class C (41% [$67 658]; P<.001); care from the intensive care unit at time of transplant (42 % [$77 833]; P<.001); death in the hospital (35% [$67 076]; P<.001); and having multiple liver transplants during the index hospitalization (154% increase [$474740 vs $186726 for 1 transplant]; P<.001). Adjusted length of stay and resource utilization also differed significantly among transplant centers Conclusions Clinical economic, and ethical dilemmas in liver transplantation are highlighted by these findings. Recipients who were older, had alcoholic liver disease, or were severely ill were the most expensive to treat; this suggests that organ allocation criteria may affect transplant costs. Clinical practices and resource utilization varied considerably among transplant centers; methods to reduce variation n practice patterns, such as clinical guidelines, might lower costs while maintaining quality of care.

Original languageEnglish (US)
Pages (from-to)1381-1386
Number of pages6
JournalJournal of the American Medical Association
Volume281
Issue number15
DOIs
StatePublished - Apr 21 1999

Fingerprint

Liver Transplantation
Transplants
Alcoholic Liver Diseases
Liver
Costs and Cost Analysis
San Francisco
Quality of Health Care
Intensive Care Units
Liver Diseases
Length of Stay
Hospitalization
Economics
Outcome Assessment (Health Care)
Tissue Donors
Databases
Guidelines

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Showstack, J., Katz, P. P., Lake, J. R., Brown, R. S., Dudley, R. A., Belle, S., ... Everhart, J. (1999). Resource utilization in liver transplantation: Effects of patient characteristics and clinical practice. Journal of the American Medical Association, 281(15), 1381-1386. https://doi.org/10.1001/jama.281.15.1381

Resource utilization in liver transplantation : Effects of patient characteristics and clinical practice. / Showstack, Jonathan; Katz, Patricia P.; Lake, John R.; Brown, Robert S.; Dudley, R. Adams; Belle, Steven; Wiesner, Russell H.; Zetterman, Rowen K.; Everhart, James.

In: Journal of the American Medical Association, Vol. 281, No. 15, 21.04.1999, p. 1381-1386.

Research output: Contribution to journalArticle

Showstack, J, Katz, PP, Lake, JR, Brown, RS, Dudley, RA, Belle, S, Wiesner, RH, Zetterman, RK & Everhart, J 1999, 'Resource utilization in liver transplantation: Effects of patient characteristics and clinical practice', Journal of the American Medical Association, vol. 281, no. 15, pp. 1381-1386. https://doi.org/10.1001/jama.281.15.1381
Showstack, Jonathan ; Katz, Patricia P. ; Lake, John R. ; Brown, Robert S. ; Dudley, R. Adams ; Belle, Steven ; Wiesner, Russell H. ; Zetterman, Rowen K. ; Everhart, James. / Resource utilization in liver transplantation : Effects of patient characteristics and clinical practice. In: Journal of the American Medical Association. 1999 ; Vol. 281, No. 15. pp. 1381-1386.
@article{6605202775d54ce7b58cff83d457d505,
title = "Resource utilization in liver transplantation: Effects of patient characteristics and clinical practice",
abstract = "Context Liver transplantation is among the most costly of medical services, yet few studies have addressed the relationship between the resources utilized for this procedure and specific patient characteristics and clinical practices. Objective To assess the association of pretransplant patient characteristics and clinical practices with hospital resource utilization. Design Prospective cohort of patients who received liver transplants between January 1991 and July 1994. Setting University of California, San Francisco; Mayo Clinic, Rochester, Minn; and the University of Nebraska, Omaha. Patients Seven hundred eleven patients who received single-organ liver transplants, were at least 16 years old, and had nonfulminant liver disease. Main Outcome Measure Standardized resource utilization derived from a database created by matching all services to a single price list. Results Higher adjusted resource utilization was associated with donor age of 60 years or older (28{\%} [$53 813] greater mean resource utilization; P= .005); recipient age of 60 years or older (17{\%} [$32 795]; P = .01); alcoholic liver disease (26{\%} [$49 596]; P = .002); Child- Pugh class C (41{\%} [$67 658]; P<.001); care from the intensive care unit at time of transplant (42 {\%} [$77 833]; P<.001); death in the hospital (35{\%} [$67 076]; P<.001); and having multiple liver transplants during the index hospitalization (154{\%} increase [$474740 vs $186726 for 1 transplant]; P<.001). Adjusted length of stay and resource utilization also differed significantly among transplant centers Conclusions Clinical economic, and ethical dilemmas in liver transplantation are highlighted by these findings. Recipients who were older, had alcoholic liver disease, or were severely ill were the most expensive to treat; this suggests that organ allocation criteria may affect transplant costs. Clinical practices and resource utilization varied considerably among transplant centers; methods to reduce variation n practice patterns, such as clinical guidelines, might lower costs while maintaining quality of care.",
author = "Jonathan Showstack and Katz, {Patricia P.} and Lake, {John R.} and Brown, {Robert S.} and Dudley, {R. Adams} and Steven Belle and Wiesner, {Russell H.} and Zetterman, {Rowen K.} and James Everhart",
year = "1999",
month = "4",
day = "21",
doi = "10.1001/jama.281.15.1381",
language = "English (US)",
volume = "281",
pages = "1381--1386",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "15",

}

TY - JOUR

T1 - Resource utilization in liver transplantation

T2 - Effects of patient characteristics and clinical practice

AU - Showstack, Jonathan

AU - Katz, Patricia P.

AU - Lake, John R.

AU - Brown, Robert S.

AU - Dudley, R. Adams

AU - Belle, Steven

AU - Wiesner, Russell H.

AU - Zetterman, Rowen K.

AU - Everhart, James

PY - 1999/4/21

Y1 - 1999/4/21

N2 - Context Liver transplantation is among the most costly of medical services, yet few studies have addressed the relationship between the resources utilized for this procedure and specific patient characteristics and clinical practices. Objective To assess the association of pretransplant patient characteristics and clinical practices with hospital resource utilization. Design Prospective cohort of patients who received liver transplants between January 1991 and July 1994. Setting University of California, San Francisco; Mayo Clinic, Rochester, Minn; and the University of Nebraska, Omaha. Patients Seven hundred eleven patients who received single-organ liver transplants, were at least 16 years old, and had nonfulminant liver disease. Main Outcome Measure Standardized resource utilization derived from a database created by matching all services to a single price list. Results Higher adjusted resource utilization was associated with donor age of 60 years or older (28% [$53 813] greater mean resource utilization; P= .005); recipient age of 60 years or older (17% [$32 795]; P = .01); alcoholic liver disease (26% [$49 596]; P = .002); Child- Pugh class C (41% [$67 658]; P<.001); care from the intensive care unit at time of transplant (42 % [$77 833]; P<.001); death in the hospital (35% [$67 076]; P<.001); and having multiple liver transplants during the index hospitalization (154% increase [$474740 vs $186726 for 1 transplant]; P<.001). Adjusted length of stay and resource utilization also differed significantly among transplant centers Conclusions Clinical economic, and ethical dilemmas in liver transplantation are highlighted by these findings. Recipients who were older, had alcoholic liver disease, or were severely ill were the most expensive to treat; this suggests that organ allocation criteria may affect transplant costs. Clinical practices and resource utilization varied considerably among transplant centers; methods to reduce variation n practice patterns, such as clinical guidelines, might lower costs while maintaining quality of care.

AB - Context Liver transplantation is among the most costly of medical services, yet few studies have addressed the relationship between the resources utilized for this procedure and specific patient characteristics and clinical practices. Objective To assess the association of pretransplant patient characteristics and clinical practices with hospital resource utilization. Design Prospective cohort of patients who received liver transplants between January 1991 and July 1994. Setting University of California, San Francisco; Mayo Clinic, Rochester, Minn; and the University of Nebraska, Omaha. Patients Seven hundred eleven patients who received single-organ liver transplants, were at least 16 years old, and had nonfulminant liver disease. Main Outcome Measure Standardized resource utilization derived from a database created by matching all services to a single price list. Results Higher adjusted resource utilization was associated with donor age of 60 years or older (28% [$53 813] greater mean resource utilization; P= .005); recipient age of 60 years or older (17% [$32 795]; P = .01); alcoholic liver disease (26% [$49 596]; P = .002); Child- Pugh class C (41% [$67 658]; P<.001); care from the intensive care unit at time of transplant (42 % [$77 833]; P<.001); death in the hospital (35% [$67 076]; P<.001); and having multiple liver transplants during the index hospitalization (154% increase [$474740 vs $186726 for 1 transplant]; P<.001). Adjusted length of stay and resource utilization also differed significantly among transplant centers Conclusions Clinical economic, and ethical dilemmas in liver transplantation are highlighted by these findings. Recipients who were older, had alcoholic liver disease, or were severely ill were the most expensive to treat; this suggests that organ allocation criteria may affect transplant costs. Clinical practices and resource utilization varied considerably among transplant centers; methods to reduce variation n practice patterns, such as clinical guidelines, might lower costs while maintaining quality of care.

UR - http://www.scopus.com/inward/record.url?scp=0033590916&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033590916&partnerID=8YFLogxK

U2 - 10.1001/jama.281.15.1381

DO - 10.1001/jama.281.15.1381

M3 - Article

C2 - 10217053

AN - SCOPUS:0033590916

VL - 281

SP - 1381

EP - 1386

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 15

ER -