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Liver transplantation at safety net hospitals: Potentially vulnerable patients with noninferior outcomes.

Publication ,  Journal Article
Lee, TC; Dhar, VK; Hoehn, RS; Wima, K; Kim, Y; Ertel, AE; Patel, SH; Shah, SA
Published in: Surgery
December 2019

BACKGROUND: Patients undergoing complex surgery at safety net hospitals have been shown to suffer inferior short-term outcomes. Liver transplantation, one of the most complex surgical interventions, is offered at certain safety net hospitals. We sought to identify whether patients undergoing liver transplantation at safety net hospitals have inferior outcomes compared with lower burden centers. METHODS: Using a link between the University HealthSystem Consortium and Scientific Registry of Transplant Recipient databases, we identified 11,047 patients undergoing liver transplantation at 63 centers between 2009 and 2012. Hospitals were grouped by safety net burden, defined as the proportion of Medicaid or uninsured patient encounters during that time. The highest quartile (safety net hospitals) was compared to medium- and low-burden hospitals regarding recipient and donor characteristics, perioperative outcomes, and long-term survival. RESULTS: Liver transplantation recipients at safety net hospitals were more often black and of lower socioeconomic status (P < .01), but had similar model for end-stage liver disease scores (20 vs 20 vs 18) compared with median-burden hospitals and low burden hospitals. Length of stay and readmission rates were similar; however, safety net hospitals demonstrated higher in-hospital mortality (5.2% vs 4.5% vs 2.9%, P < .01). Despite this, there was no significant difference in overall patient or graft survivals in patients who underwent liver transplantation at safety net hospitals and survived the perioperative setting at a median follow-up of 2 years (P > .05). CONCLUSION: Despite differences in perioperative outcomes at safety net hospitals, these centers achieve noninferior long-term patient and graft survival for potentially vulnerable patients requiring liver transplantation. Strict care standardization, as achieved in liver transplantation, may be a mechanism by which outcomes can be improved at safety net hospitals after other complex surgical procedures.

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Published In

Surgery

DOI

EISSN

1532-7361

Publication Date

December 2019

Volume

166

Issue

6

Start / End Page

1135 / 1141

Location

United States

Related Subject Headings

  • Young Adult
  • Vulnerable Populations
  • United States
  • Treatment Outcome
  • Surgery
  • Social Class
  • Severity of Illness Index
  • Safety-net Providers
  • Retrospective Studies
  • Registries
 

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Lee, T. C., Dhar, V. K., Hoehn, R. S., Wima, K., Kim, Y., Ertel, A. E., … Shah, S. A. (2019). Liver transplantation at safety net hospitals: Potentially vulnerable patients with noninferior outcomes. Surgery, 166(6), 1135–1141. https://doi.org/10.1016/j.surg.2019.06.020
Lee, Tiffany C., Vikrom K. Dhar, Richard S. Hoehn, Koffi Wima, Young Kim, Audrey E. Ertel, Sameer H. Patel, and Shimul A. Shah. “Liver transplantation at safety net hospitals: Potentially vulnerable patients with noninferior outcomes.Surgery 166, no. 6 (December 2019): 1135–41. https://doi.org/10.1016/j.surg.2019.06.020.
Lee TC, Dhar VK, Hoehn RS, Wima K, Kim Y, Ertel AE, et al. Liver transplantation at safety net hospitals: Potentially vulnerable patients with noninferior outcomes. Surgery. 2019 Dec;166(6):1135–41.
Lee, Tiffany C., et al. “Liver transplantation at safety net hospitals: Potentially vulnerable patients with noninferior outcomes.Surgery, vol. 166, no. 6, Dec. 2019, pp. 1135–41. Pubmed, doi:10.1016/j.surg.2019.06.020.
Lee TC, Dhar VK, Hoehn RS, Wima K, Kim Y, Ertel AE, Patel SH, Shah SA. Liver transplantation at safety net hospitals: Potentially vulnerable patients with noninferior outcomes. Surgery. 2019 Dec;166(6):1135–1141.
Journal cover image

Published In

Surgery

DOI

EISSN

1532-7361

Publication Date

December 2019

Volume

166

Issue

6

Start / End Page

1135 / 1141

Location

United States

Related Subject Headings

  • Young Adult
  • Vulnerable Populations
  • United States
  • Treatment Outcome
  • Surgery
  • Social Class
  • Severity of Illness Index
  • Safety-net Providers
  • Retrospective Studies
  • Registries