Copyright
©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 24, 2016; 6(4): 743-750
Published online Dec 24, 2016. doi: 10.5500/wjt.v6.i4.743
Time spent in hospital after liver transplantation: Effects of primary liver disease and comorbidity
Chutwichai Tovikkai, Susan C Charman, Raaj K Praseedom, Alexander E Gimson, Jan van der Meulen
Chutwichai Tovikkai, Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Chutwichai Tovikkai, Susan C Charman, Jan van der Meulen, Clinical Effectiveness Unit, the Royal College of Surgeons of England, London WC2A 3PE, United Kingdom
Chutwichai Tovikkai, Raaj K Praseedom, Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
Susan C Charman, Jan van der Meulen, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, United Kingdom
Raaj K Praseedom, Alexander E Gimson, Liver Transplant Unit, Addenbrooke’s Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
Author contributions: Tovikkai C, Charman SC and van der Meulen J participated in research design; Tovikkai C and Charman SC performed the data and statistical analysis; Tovikkai C drafted the manuscript; all authors contributed to the interpretation of the results, commented on drafts and approved the final manuscript.
Institutional review board statement: This study is exempt United Kingdom National Research Ethics Service approval as it involved analysis of existing databases of anonymised data for service evaluation. Approval for the use of Hospital Episode Statistics data was obtained as the standard Hospital Episodes Statistics approval process.
Informed consent statement: The informed consent was exempt according to UK National Research Ethics Service as it involved analysis of existing database of anonymised data for service evaluation.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: The technical appendix and statistical code are available from the corresponding author.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chutwichai Tovikkai, MD, PhD, MRCS, FRCST, Clinical Effectiveness Unit, the Royal College of Surgeons of England, 35-43 Lincoln’s Inn Fields, London WC2A 3PE, United Kingdom. chutwichai.tov@mahidol.ac.th
Telephone: +44-2078-696624 Fax: +44-2078-696644
Received: June 25, 2016
Peer-review started: June 28, 2016
First decision: August 5, 2016
Revised: October 8, 2016
Accepted: November 1, 2016
Article in press: November 3, 2016
Published online: December 24, 2016
AIM
To explore the effect of primary liver disease and comorbidities on transplant length of stay (TLOS) and LOS in later admissions in the first two years after liver transplantation (LLOS).
METHODS
A linked United Kingdom Liver Transplant Audit - Hospital Episode Statistics database of patients who received a first adult liver transplant between 1997 and 2010 in England was analysed. Patients who died within the first two years were excluded from the primary analysis, but a sensitivity analysis was also performed including all patients. Multivariable linear regression was used to evaluate the impact of primary liver disease and comorbidities on TLOS and LLOS.
RESULTS
In 3772 patients, the mean (95%CI) TLOS was 24.8 (24.2 to 25.5) d, and the mean LLOS was 24.2 (22.9 to 25.5) d. Compared to patients with cancer, we found that the largest difference in TLOS was seen for acute hepatic failure group (6.1 d; 2.8 to 9.4) and the largest increase in LLOS was seen for other liver disease group (14.8 d; 8.1 to 21.5). Patients with cardiovascular disease had 8.5 d (5.7 to 11.3) longer TLOS and 6.0 d (0.2 to 11.9) longer LLOS, compare to those without. Patients with congestive cardiac failure had 7.6 d longer TLOS than those without. Other comorbidities did not significantly increase TLOS nor LLOS.
CONCLUSION
The time patients spent in hospital varied according to their primary liver disease and some comorbidities. Time spent in hospital of patients with cancer was relatively short compared to most other indications. Cardiovascular disease and congestive cardiac failure were the comorbidities with a strong impact on increased LOS.
Core tip: Time patients spent in hospital in transplant admission and in later admissions after liver transplantation may reflect the success of liver transplantation. By analysing a linked United Kingdom Liver Transplant Audit - Hospital Episode Statistics database between 1997 and 2010, we found that average transplant length of stay (LOS) was 24.8 d, and mean LOS of all admissions in the first two years after transplantation was 24.2 d. Primary liver disease and comorbidities had a significant impact on LOS. Patients transplanted for cancer has shorter LOS compared to other indications. Cardiovascular disease and congestive cardiac failure were associated with increased LOS.
