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Piñero F, Fauda M, Quiros R, Mendizabal M, González-Campaña A, Czerwonko D, Barreiro M, Montal S, Silberman E, Coronel M, Cacheiro F, Raffa P, Andriani O, Silva M, Podestá LG. Predicting early discharge from hospital after liver transplantation (ERDALT) at a single center: a new model. Ann Hepatol 2016; 14:845-55. [PMID: 26436356 DOI: 10.5604/16652681.1171770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND & RATIONALE Limited information related to Liver Transplantation (LT) costs in South America exists. Additionally, costs analysis from developed countries may not provide comparable models for those in emerging economies. We sought to evaluate a predictive model of Early Discharge from Hospital after LT (ERDALT = length of hospital stay ≤ 8 days). A predictive model was assessed based on the odds ratios (OR) from a multivariate regression analysis in a cohort of consecutively transplanted adult patients in a single center from Argentina and internally validated with bootstrapping technique. RESULTS ERDALT was applicable in 34 of 289 patients (11.8%). Variables independently associated with ERDALT were MELD exception points OR 1.9 (P = 0.04), surgery time < 4 h OR 3.8 (P = 0.013), < 5 units of blood products consumption (BPC) OR 3.5 (P = 0.001) and early weaning from mechanical intubation OR 6.3 (P = 0.006). Points in the predictive scoring model were allocated as follows: MELD exception points (absence = 0 points, presence = 1 point), surgery time < 4 h (0-2 points), < 5 units of BPC (0-2 points), and early weaning (0-3 points). Final scores ranged from 0 to 8 points with a c-statistic of 0.83 (95% CI 0.77-0.90; P < 0.0001). Transplant costs were significantly lower in patients with ERDALT (median $23,078 vs. $28,986; P < 0.0001). Neither lower patient and graft survival, nor higher rates of short-term re-hospitalization and acute rejection events after discharge were observed in patients with ERDALT. In conclusion, the ERDALT score identifies patients suitable for early discharge with excellent outcomes after transplantation. This score may provide applicable models particularly for emerging economies.
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Affiliation(s)
- Federico Piñero
- Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina
| | - Martín Fauda
- Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina
| | - Rodolfo Quiros
- Internal Medicine, Infectious Diseases and Statistics. Hospital Universitario Austral, Buenos Aires, Argentina
| | - Manuel Mendizabal
- Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina
| | - Ariel González-Campaña
- Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina
| | - Demian Czerwonko
- Intensive Care Unit. Hospital Universitario Austral, Buenos Aires, Argentina
| | - Mariano Barreiro
- Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina
| | - Silvina Montal
- Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina
| | - Ezequiel Silberman
- Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina
| | - Matías Coronel
- Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina
| | - Fernando Cacheiro
- Department of Anesthesiology. Hospital Universitario Austral, Buenos Aires, Argentina
| | - Pía Raffa
- Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina
| | - Oscar Andriani
- Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina
| | - Marcelo Silva
- Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina
| | - Luis G Podestá
- Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina
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