Impact of new allocation system on length of stay following heart transplantation in the United States

Author:

Doulamis Ilias P.12ORCID,Gemelli Marco3ORCID,Rempakos Athanasios4,Tzani Aspasia5,Oh Nicholas A.6,Kampaktsis Polydoros7ORCID,Guariento Alvise8,Kuno Toshiki9,Alvarez Paulino10,Briasoulis Alexandros411ORCID

Affiliation:

1. Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA

2. Department of Surgery Lahey Hospital and Medical Center Burlington MA USA

3. Cardiac Surgery Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Padua Italy

4. Medical School of Athens National and Kapodistrian University of Athens Athens Greece

5. Brigham and Women's Hospital Heart and Vascular Center Harvard Medical School Boston Massachusetts USA

6. Department of Thoracic and Cardiovascular Surgery Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland Ohio USA

7. Division of Cardiology Columbia University Irving Medical Center New York City New York USA

8. Pediatric and Congenital Cardiac Surgery Unit Department of Cardiac Thoracic, Vascular Sciences and Public Health University of Padua Padua Italy

9. Department of Cardiology Montefiore Medical Center Albert Einstein College of Medicine New York City New York USA

10. Division of Cardiology Cleveland Clinic Foundation Cleveland Ohio USA

11. Division of Cardiovascular Medicine Section of Heart Failure and Transplantation University of Iowa Iowa City Iowa USA

Abstract

AbstractBackgroundUnited Network for Organ Sharing (UNOS) allocation criteria changed in 2018 to accommodate the increased prevalence of ventricular assist device use as a bridge to heart transplant, which consequently prioritized sicker patients. We aimed to assess the impact of this new allocation policy on the length of stay following heart transplantation. Secondary outcomes include other risk factors for prolonged hospitalization and its effect on mortality and postoperative complications.MethodsThe UNOS Registry was queried to identify patients who underwent isolated heart transplants in the United States between 2001 and 2023. Patients were divided into quartiles according to their respective length of stay.ResultsA total of 57 020 patients were included, 15 357 of which were allocated with the new system. The median hospital length of stay was 15 days (mean 22.7 days). Length of stay was longer in the new allocation era (25 ± 30 vs. 22 ± 27 days, p < .001). The longer length of stay was associated with increased 5‐year mortality in the new allocation system (aHR: 1.18; 95% CI: 1.15, 1.20; p‐value: < .001).ConclusionLonger hospital stays and associated observed increased risk for mortality in the era after the allocation criteria change reflect the rationale of this shift which was to prioritize heart transplants for sicker patients. Further studies are needed to track the progress of surgical and perioperative management of these studies over time.

Publisher

Wiley

Subject

Transplantation

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