Liver transplant recipients (LTR), like the general population, often require surgical procedures for non-transplant related issues. Given the need for immunosuppression and the physiologic impact of years of liver failure, we hypothesized that colectomy might have higher risks for LTR. We investigated the differences in morbidity, LOS, and cost between LTR and non-LTR undergoing colectomy at both transplant and non-transplant centers nationwide.

METHODS: The Nationwide Inpatient Sample was used to study 750 adult LTR and 1,433,442 non-LTR who underwent colectomy from 2000-13. Morbidity, defined as postoperative complications, was identified by ICD-9 code. Complication rates, LOS, and cost were compared using hierarchical logistic regression, hierarchical negative binomial regression, and mixed effects log-linear models respectively.

RESULTS: The mortality rate among LTR was similar to non-LTR (6.0 vs 4.3%, p 0.3). Morbidity was also similar (33.4 vs 31.5%, p 0.6; adjusted OR 0.96, 95% 0.68-1.36). Significantly more intraoperative complications were seen in LTR patients compared to non-LTR but became insignificant after adjustment (7.2 vs 4.0%, p=0.04; adjusted OR 1.67, 95% CI 0.89 – 3.11). LOS was longer (13.3 vs 9.8 days, p= 0.002) and hospital costs were greater ($32,632 vs $22,263, p = 0.002) for LTR compared to non-LTR (Table 1). Following adjustment for patient and hospital level factors, LOS (1.19, 95%CI 1.07-1.33) and cost (ratio 1.22, 95%CI 1.08-1.39) remained higher for LTR compared to non-LTR (Table 2). These findings were similar regardless of whether colectomy was performed at a transplant center.

CONCLUSION: LTR have similar mortality and morbidity, but stay longer and cost more, using more resources. Physicians should anticipate these issues, targeting perioperative management to streamline care and decrease LOS and cost.

CITATION INFORMATION: DiBrito S, Alimi Y, Haugen C, Olorundare I, Segev D, Garonzik-Wang J. Outcomes Following Colectomy in Liver Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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