Z. Moghadamyeghaneh1, A. Masi1, R. W. Gruessner1 1State University of New York Downstate,Surgery,Brooklyn, NEW YORK, USA
Introduction: Hospital Acquired Conditions (HAC) are used by Medicare/Medicaid Services to define hospital performance measures that dictate payments/penalties. However, pre-op patient comorbidity may significantly influence HAC development.
Methods: The NIS database (2002-2014) was used to investigate HAC for the patients who underwent liver transplantation. Multivariate analysis, using logistic regression, was used to identify HAC risk factors.
Results: We found a total of 15,048 patients who underwent liver transplantation during 2002-2014. Of these 190(1.3%) had a report of HAC. There was a steady increase in rate of HAC after liver transplantation in US over 13 years of study (Figure 1). HAC were associated with increased: mean hospitalization-length (56 vs 21 days, P<0.01), hospital-charges ($807,506 vs $355,603, P<0.01), but not mortality (11.6% vs 5%, AOR:1.14, P=0.51). Most frequent HAC were: vascular catheter-associated infection [121(0.8%)], pressure ulcer stage III/IV [24(0.2%)], catheter-associated urinary tract infection [21(0.1%)], and fall and trauma [19(0.1%)]. The strongest factors correlating with HAC included: high-risk patients with significant comorbidity before transplantation [major or extreme loss function pre-op (AOR: 6.39, P=0.01), High or extreme mortality risk before transplantation (AOR: 2.36, P=0.03), preoperative weight loss (AOR: 1.76, P<0.01), and hospital factor of private vs. governmental hospital (AOR: 2.50, P<0.01). Hospital factors of bed size [large vs. small] (AOR: 1.46, P=0.17), teaching vs. non-teaching (AOR: 1.14, P=0.89) did not have significant associations with HAC.
Conclusion: The rate of HAC for liver transplantation (1.3%) is higher than the overall reported rate of HAC for GI procedure. There is a steady increase in rate of HAC since 2002 which can be related to adaptation of MELD score for liver transplantation. Multiple non-modifiable patient factors (preoperative loss function, high or extreme mortality risk, weight loss, etc.) associated with HAC so rate of HAC is not a reliable measure to evaluate hospital performance. Vascular catheter-associated infection is the most common HAC after liver transplantation which can be avoidable. Considering private hospitals have increased HAC risk compared to governmental hospitals, improvement in such hospitals settings may decrease rate of the complications.
