Liver transplant length of stay (LOS) index: A novel predictive score for hospital length of stay following liver transplantation

Abstract

An index to predict hospital length of stay after liver transplantation could address unmet clinical needs. Length of stay is an important surrogate for hospital costs and efforts to limit stays can preserve our healthcare resources. Here, we devised a scoring system that predicts hospital length of stay following liver transplantation. We used univariate and multivariate analyses on 73 635 adult liver transplant recipient data and identified independent recipient and donor risk factors for prolonged hospital stay (>30 days). Multiple imputation was used to account for missing variables. We identified 22 factors as significant predictors of prolonged hospital stay, including the most significant risk factors: intensive care unit (ICU) admission (OR 1.75, CI 1.58-1.95) and previous transplant (OR 1.60, CI 1.47-1.75). The length of stay (LOS) index assigns weighted risk points to each significant factor in a scoring system to predict prolonged hospital stay after liver transplantation with a c-statistic of 0.75. The LOS index demonstrated good discrimination across the entire population, dividing the cohort into tertiles, which had odds ratios of 2.25 (CI 2.06-2.46) and 7.90 (7.29-8.56) for prolonged hospital stay (>30 days). The LOS index utilizes 22 significant donor and recipient factors to accurately predict hospital length of stay following liver transplantation. The index further demonstrates the basis for a clear clinical recommendation to mitigate risk of long hospitalization by minimizing cold ischemia time.

The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia

“…Our study identified several independent baseline associations with prolonged hospitalization. Other studies have similarly revealed that increasing age [ 12 , 17 , 18 , 20 , 22 , 24 , 25 , 28 , 29 , 30 , 33 , 34 , 36 , 38 , 39 , 40 , 50 ], female gender [ 22 , 24 , 26 , 30 , 36 , 39 , 50 ], not being in a relationship, [ 52 ] being a current smoker [ 39 ], level of co-morbidity [ 11 , 12 , 14 , 15 , 16 , 18 , 22 , 26 , 40 , 42 , 44 ], weekend admissions [ 42 ], and the number of prior admissions [ 25 , 32 , 44 ] were associated with prolonged hospitalization.…”

“…Most previous studies of prolonged hospitalization have focused on specific sub-groups of patients such as orthopaedic procedures [ 21 , 24 , 26 , 29 , 30 , 31 , 39 ], cardiovascular disease [ 13 , 15 , 17 , 36 , 37 , 38 ], solid organ transplantation [ 33 , 50 ], or oncological conditions [ 11 , 14 , 18 , 20 , 27 , 28 , 34 , 35 ] ( Supplementary Table S7 ). A limited number of studies have examined the epidemiology of prolonged hospitalization in internal medicine patients [ 23 , 45 , 51 ] but only one of these was multi-centre in nature [ 51 ].…”

“…Several studies have identified factors associated with protracted hospitalization, but many of these have focused on targeted patient populations [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ] or involved data collected at a single centre [ 13 , 18 , 19 , 23 , 24 , 28 , 29 , 31 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ] Understanding the factors that contribute to prolonged hospitalization in a broader patient cohort may guide the development of interventions that target at risk patients, improve overall care, and reduce resource utilisation.…”

Graft Risk Index After Liver Transplant: Internal and External Validation of a New Spanish Indicator

“…Stratigopoulou and colleagues 18 confirmed that MELD and transplant duration are independent predictors of prolonged ICU stay. However, Rana and associates 19 hospital stay, the 2 most significant were shown to be previous admission of the recipient to the ICU (odds ratio of 1.75; 95% CI, 1.58-1.95) and previous transplant (odds ratio of 1.60; 95% CI, 1.47-1.75).…”

Hospitalization Before Liver Transplantation Predicts Posttransplant Patient Survival: A Propensity Score–Matched Analysis

“…It subsumes comorbidities, fitness, and biological age among other things and has been described as an adverse predictor for various outcome points after LT, such as morbidity, survival, and length of stay after LT as well as posttransplant hospital readmissions. ( 16‐19 ) These findings were mostly limited to the time point directly prior to LT and did not evaluate in detail the period of time these patients had been hospitalized.…”