Increased Resource Use in Lung Transplant Admissions in the Lung Allocation Score Era

Abstract

Rationale: In 2005, the lung allocation score (LAS) was implemented to prioritize organ allocation to minimize waiting-list mortality and maximize 1-year survival. It resulted in transplantation of older and sicker patients without changing 1-year survival. Its effect on resource use is unknown.Objectives: To determine changes in resource use over time in lung transplant admissions.Methods: Solid organ transplant recipients were identified within the Nationwide Inpatient Sample (NIS) data from 2000 to 2011. Joinpoint regression methodology was performed to identify a time point of change in mean total hospital charges among lung transplant and other solid-organ transplant recipients. Two temporal lung transplant recipient cohorts identified by joinpoint regression were compared for baseline characteristics and resource use, including total charges for index hospitalization, charges per day, length of stay, discharge disposition, tracheostomy, and need for extracorporeal membrane oxygenation.Measurements and Main Results: A significant point of increased total hospital charges occurred for lung transplant recipients in 2005, corresponding to LAS implementation, which was not seen in other solid-organ transplant recipients. Total transplant hospital charges increased by 40% in the post-LAS cohort ($569,942 [$53,229] vs. $407,489 [$28,360]) along with an increased median length of stay, daily charges, and discharge disposition other than to home. Post-LAS recipients also had higher post-transplant use of extracorporeal membrane oxygenation (odds ratio, 2.35; 95% confidence interval, 1.56-3.55) and higher incidence of tracheostomy (odds ratio, 1.52; 95% confidence interval, 1.22-1.89).Conclusions: LAS implementation is associated with a significant increase in resource use during index hospitalization for lung transplant.

Effect of Transplant Center Volume on Cost and Readmissions in Medicare Lung Transplant Recipients

“…We have previously demonstrated increased transplant admission resource use within the post-LAS era (2). This study builds on that work by describing recipient factors associated with increased resource use.…”

“…In the present era of increased emphasis on health-care cost containment and in light of the recent recognition of increasing resource use in lung transplantation, there is a need to identify how to reduce lung transplant cost without sacrificing lung transplant access, quality, or outcomes (2). In this study, we have shown that low-volume transplant centers provide transplant admission care at a greater cost than high-volume centers while also demonstrating higher adjusted in-hospital mortality and excess risk for early hospital readmission.…”

“…While advancements in the field have led to improvements in recipient survival, the health-care resources associated with this procedure within the United States have risen, particularly after implementation of the lung allocation score (LAS) (1,2). The resources attributed to this operation are considerable, with per-person Medicare costs averaging $236,450 over the first post-transplant year (3).…”

Effect of Lung Transplantation on Health-Related Quality of Life in the Era of the Lung Allocation Score: A U.S. Prospective Cohort Study

“…(6) Morbidity and mortality after the first post-operative year have also increased in this period. (7, 8)…”

Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation

“…After lung transplants, nearly the same proportion of patients die within the first postoperative year (2). Notably, serious morbidity after transplant is increasing, with resultant disability and associated decrements in health-related quality of life (3,4). Although known risk factors for death are already incorporated into lung allocation in the United States (Lung Allocation Score [LAS]), persistently high mortality and increasing morbidity underscore the need to identify novel risk factors for poor outcomes to maximize the individual and societal benefit of lung transplants (5).…”