A. Flores-Huidobro Martinez1, A. Gomez-Llerena1, 5, A. Mishra1, J. Sanchez-Garcia4, J. Maughan6, E. N. Calvario-Sanchez4, R. Byrd6, M. Segoviano-Valdivia3, S. Erdene2, R. R. Price1, M. I. Rodriguez-Davalos1, 4 5Universidad Anahuac Mexico, Facultad De Medicina, Huixquilucan, MEXICO, Mexico 6Primary Children’s Hospital, Transplant, Salt Lake City, UT, USA 1University Of Utah School of Medicine, Center For Global Surgery, Salt Lake City, UT, USA 2First Central Hospital of Mongolia, Transplant, Ulaanbaatar, ULAANBAATAR, Mongolia 3Hospital Country 2000, Transplant, Guadalajara, JALISCO, Mexico 4Intermountain Medical Center, Liver Transplant Service, Salt Lake City, UT, USA
Introduction: Liver Transplantation is the standard of care for patients with end stage liver disease. Liver transplantation is generally performed in specialized centers that provide high level of care, which is frequently associated with high healthcare related costs, which can be driven by OR time, surgical staff, and materials used during the surgery. Through work in global transplant we observed that the number of surgical instruments used in transplantation varies across the world, which can ultimately impact transplant-related costs. Specifically, we aimed to determine the number of instruments utilized in liver transplant cases in hospitals located in different countries and continents.
Methods: This is a cross-sectional, observational study. Transplant centers who are members of our global surgery collaboration group were invited to participate in the study. Centers were queried on the number of surgical instruments used in a first liver-only transplant case (ie, repeat transplant, simultaneous liver-kidney transplant cases were not included). Pearson’s test was used to assess the correlation between number of surgical instruments with gross domestic product (GDP) and transplant program years of experience.
Results: Five transplant centers were invited to participate, of which all are included in this study (100% response rate). Transplant centers were located in North America (n = 4), and Asia (n = 1). The number of instruments used in a first liver-only transplant were 70, 123, 145, 239, and 342 among participating centers, respectively. The center using the least number of instruments (70) was located in Mexico, whereas the transplant program using the highest number of instruments (342) was located in the United States. No correlation was identified between the number of instruments and program years of experience (r=0.86, p=0.064) or national GDP (r= 0.45, p= 0.45).
Conclusion: There is variability in the number of instruments used for liver transplantation, there is no correlation in the geographical area, national GDP or years of experience .This preliminary data indicates that fewer instruments can be used for the same type of surgery. Studies have shown that for each procedure there is a recurrent expenditure for hospitals due to the usage and sterilization related damage and replacement of instruments. In future studies we aim to include other variables like OR time, suture materials, immunosuppression and costs to further investigate if a modification would significantly decrease transplant surgery costs worldwide.
