We sought to improve value (outcomes/cost) for the initial hospitalization after pediatric liver transplantation (LT) by identifying variation in length of stay (LOS), a highly correlative cost surrogate, among LT centers and opportunities to decrease preventable discharge delays. METHODS. We queried 25 SPLIT centers for LOS after LT from 2005-2008, limiting our study to 380 children with biliary atresia (BA) to decrease the analysis effect of primary disease. Transplant volume reported to UNOS, BA patient concentration, LOS, intensive care unit (ICU) LOS, and duration of intubation (DoI) were included as primary variables. Pre-LT PELD score, age, graft type, and post-operative complications were secondary variables. Centers were categorically graded using a Statistical Process Control analysis of primary variables to generate aggregate categorical and center-specific discharge efficiency grades. ANOVA was performed to distinguish high-performing centers (HPC). RESULTS. The cohort mean LOS was 21.8 days and normally distributed. The mean LOS, ICU LOS, and DoI were significantly lower in the HPC.

Center performance was independent of LT volume. There were no significant differences in secondary variables. Queried HPC care processes highlighted optimizing intraoperative fluid balance, delayed abdominal closure in infants, OR extubation, minimizing post-op fluid and sedation, early feed initiation and immunosuppression, daily team discussion of barriers to discharge, daily patient/parent education and discharge readiness assessment to minimize LOS. CONCLUSION. Multi-center data combined with collaborative efforts can be leveraged to provide center-specific performance metrics and high-performer best practices. Streamlining ICU and early extubation protocols can efficiently decrease LOS after liver transplant and improve value.

« Back to 2013 American Transplant Congress