Who pays for biliary complications following liver transplant? A business case for quality improvement

M. J. Englesbe, J. Dimick, A. Mathur, Y. Ads, T. H. Welling, S. J. Pelletier, D. G. Heidt, J. C. Magee, R. S. Sung, J. D. Punch, D. W. Hanto, D. A. Campbell

Research output: Contribution to journalReview articlepeer-review

47 Scopus citations

Abstract

We use biliary complication following liver transplantation to quantify the financial implications of surgical complications and make a case for surgical improvement initiatives as a sound financial investment. We reviewed the medical and financial records of all liver transplant patients at the UMHS between July 1, 2002 and June 30, 2005 (N = 256). The association of donor, transplant, recipient and financial data points was assessed using both univariable (Student's t-test, a chi-square and logistic regression) and multivariable (logistic regression) methods. UMHS made a profit of $6822 ± 39 087 on patients without a biliary complication while taking a loss of $5742 ± 58 242 on patients with a biliary complication (p = 0.04). Reimbursement by the payer was $55 362 higher in patients with a biliary complication compared to patients without a biliary complication (p = 0.001). Using multivariable logistic regression analysis, the two independent risk factors for a negative margin included private insurance (compared to public) (OR 1.88, CI 1.10-3.24, p = 0.022) and biliary leak (OR = 2.09, CI 1.06-4.13, p = 0.034). These findings underscore the important impact of surgical complications on transplant finances. Medical centers have a financial interest in transplant surgical quality improvement, but payers have the most to gain with improved surgical outcomes.

Original languageEnglish (US)
Pages (from-to)2978-2982
Number of pages5
JournalAmerican Journal of Transplantation
Volume6
Issue number12
DOIs
StatePublished - Dec 2006

Keywords

  • Biliary complication
  • Liver transplant
  • Quality improvement
  • Surgical complications
  • Transplant finances

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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