Affiliation:
1. Department of Anesthesiology Duke University Medical Center Durham North Carolina USA
2. Department of Biostatistics and Bioinformatics Duke University Medical Center Durham North Carolina USA
3. Department of Surgery Duke University Medical Center Durham North Carolina USA
4. Department of Medicine and Duke Clinical Research Institute Duke University School of Medicine Durham North Carolina USA
Abstract
AbstractIntroductionThe advent of new technologies to reduce primary graft dysfunction (PGD) and improve outcomes after heart transplantation are costly. Adoption of these technologies requires a better understanding of health care utilization, specifically the costs related to PGD.MethodsRecords were examined from all adult patients who underwent orthotopic heart transplantation (OHT) between July 1, 2013 and July 30, 2019 at a single institution. Total costs were categorized into variable, fixed, direct, and indirect costs. Patient costs from time of transplantation to hospital discharge were transformed with the z‐score transformation and modeled in a linear regression model, adjusted for potential confounders and in‐hospital mortality. The quintile of patient costs was modeled using a proportional odds model, adjusted for confounders and in‐hospital mortality.Results359 patients were analyzed, including 142 with PGD and 217 without PGD. PGD was associated with a .42 increase in z‐score of total patient costs (95% CI: .22‐.62; p < .0001). Additionally, any grade of PGD was associated with a 2.95 increase in odds for a higher cost of transplant (95% CI: 1.94‐4.46, p < .0001). These differences were substantially greater when PGD was categorized as severe. Similar results were obtained for fixed, variable, direct, and indirect costs.ConclusionsPGD after OHT impacts morbidity, mortality, and health care utilization. We found that PGD after OHT results in a significant increase in total patient costs. This increase was substantially higher if the PGD was severe.SummaryPrimary graft dysfunction after heart transplantation impacts morbidity, mortality, and health care utilization. PGD after OHT is costly and investments should be made to reduce the burden of PGD after OHT to improve patient outcomes.
Reference13 articles.
1. Organ Procurement and Transplantation Network(OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2020 Annual Data Report. Published 2022. Accessed September 13 2022.http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx
2. Incidence and impact of primary graft dysfunction in adult heart transplant recipients: A systematic review and meta-analysis
3. Innovations in Heart Transplantation: A Review
4. ShudoY et al.A Paradigm Shift in Heart Preservation: Improved Survival Reported in Recipients of Donor Hearts Preserved with the Paragonix SherpaPak System in a Multi‐Center Analysis of Over 500 Subject – Conclusions from Real‐World Evidence. Under Review.
5. Increasing utilization of extended criteria donor hearts for transplantation using portable normothermic perfusion and assessment with the organ care system (OCS) heart: short and long‐term results of the OCS heart EXPAND multi‐center trial;Schroder JN;J Heart Lung Transplant,2022
Cited by
2 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献