Introduction. This study's objective was to identify risk factors associated with reoperation for bleeding following liver transplantation (LTx). Methods. A retrospective study was performed at a single institution between 2001 and 2012. Operative reports were used to identify patients who underwent reoperation for bleeding within 2 weeks following LTx (operations for nonbleeding etiologies were excluded). Results. Reoperation for bleeding was observed in 101/928 (10.8%) of LTx patients. The following characteristics were associated with reoperation on multivariable analysis: recipient MELD score (OR 1.06/MELD unit, 95% CI 1.03, 1.09), number of platelets transfused (OR 0.73/platelet unit, 95% CI 0.58, 0.91), and aminocaproic acid utilization (OR 0.46, 95% CI 0.27, 0.80). LTx patients who underwent reoperation for bleeding had a longer ICU stay (5 days ± 7 versus 2 days ± 3, P < 0.001) and hospitalization (18 days ± 9 versus 10 days ± 18, P < 0.001). The risk of death increased in patients who underwent reoperation for bleeding (HR 1.89, 95% CI 1.26, 2.85). Conclusion. Reoperation for bleeding following LTx was associated with increased resource utilization and recipient mortality. A lower threshold for intraoperative platelet transfusion and antifibrinolytics, especially in patients with high lab-MELD score, may decrease the incidence of reoperation for bleeding following LTx.

Our study objective is to measure the survival impact of insurance status following liver transplantation in a cohort of uninsured “Charity care” patients. These patients are analogous to the population who will gain insurance via the Affordable Care Act. We hypothesize there will be reduced survival in Charity care compared to other insurance strata. We conducted a retrospective study of 898 liver transplants from 2000–2010. Insurance cohorts were classified as Private (n=640), Public (n=233) and Charity care (n=23). The 1, 3 and 5-year survival was 92%, 88% and 83% in Private insurance, 89%, 80% and 73% in Public insurance and 83%, 72% and 51% in Charity care. Compared to Private insurance, multivariable regression analyses demonstrated Charity care (HR 3.11, CI 1.41–6.86) and Public insurance (HR 1.58, CI 1.06 – 2.34) had a higher 5-year mortality hazard ratio. In contrast, other measures of socioeconomic status were not significantly associated with increased mortality. The Charity care cohort demonstrated the highest incidence of acute rejection and missed clinic appointments. These data suggests factors other than demographic and socioeconomic may be associated with increased mortality. Further investigations are necessary to determine causative predictors of increased mortality in liver transplant patients without Private insurance.

IntroductionSince hoverboards became available in 2015, 2.5 million have been sold in the US. An increasing number of injuries related to their use have been reported, with limited data on associated injury patterns. We describe a case series of emergency department (ED) visits for hoverboard-related injuries.MethodsWe performed a retrospective chart review on patients presenting to 10 EDs in southeastern Virginia from December 24, 2015, through June 30, 2016. We used a free-text search feature of the electronic medical record to identify patients documented to have the word “hoverboard” in the record. We reported descriptive statistics for patient demographics, types of injuries, body injury location, documented helmet use, injury severity score (ISS), length of stay in the ED, and ED charges.ResultsWe identified 83 patients in our study. The average age was 26 years old (18 months to 78 years). Of these patients, 53% were adults; the majority were female (61.4%) and African American (56.6%). The primary cause of injury was falls (91%), with an average ISS of 5.4 (0–10). The majority of injuries were contusions (37.3%) and fractures (36.1%). Pediatric patients tended to have more fractures than adults (46.2% vs 27.3%). Though 20% of patients had head injuries, only one patient reported using a helmet. The mean and median ED charges were $2,292.00 (SD $1,363.64) and $1,808.00, respectively. Head injuries resulted in a significantly higher cost when compared to other injuries; median cost was $2,846.00.ConclusionWhile the overall ISS was low, more pediatric patients suffered fractures compared to adults. Documented helmet use was low, yet 20% of our population had head injuries. Further investigation into proper protective gear and training is warranted.