BACKGROUND: In an era of economic reform we see clinical practice under increasing performance oversight. To date few studies that have looked specifically at clinical performance and subsequent resource utilization and charges in Liver Transplantation (OLT). This study analyzes clinical practice, surgical time and looks at what factor or factors might impact charges, length of stay (LOS), patient survival and graft survival.

METHODS: A retrospective review of 137 consecutive patients undergoing OLT in a 2-year period was done. The piggyback surgical technique was used in over 80% of cases. To assess costs, specific costs for variables that had these were used and otherwise charges were used for services. The Several outcome measures included operating room (OR) charges, total surgeon charges, anesthesia charges, blood and blood product costs, ICU and hospital LOS, and total primary admission charges. ANOVA was used to analyze the partial R2 between surgeons and various outcomes, with adjusting for donor risk index, MELD and recipient age.

RESULTS: Six primary surgeons were involved in the OLT. The average biological MELD was 23 at OLT and no difference in MELD at OLT by surgeon noted. In all the average LOS was 11 days, and average charges $242044 for an admission. Average surgical time was 5.07 hours with a significant difference between fastest and slowest surgeon of approximately 2 hours noted. After adjustment for DRI, MELD, and recipient age, the variation in surgeon is significantly correlated with, and accounts for, 43% of the variation in total surgery time (partial R2= 0.43), 39% of total OR charges, and 12% of the total primary admission charges. The presence of any particular surgeon however is not associated with transfusion requirement, total LOS or ICU LOS. There is a significant (p=.0001) correlation between costs incurred with surgeries lasting < 4 hours as opposed to surgeries lasting >5 hours. Variability in total surgery times and variability in total surgery charges as they relate to the 6 surgeons were 49% and 45% respectively, while only 6% of the variability in these aforementioned factors is due to donor and recipient factors.

CONCLUSIONS: Shorter OR times appear an important clinical performance measure and OR times predict costs. We believe studying SRTR program performance may show this predicts a graduate's OR times. This domain deserves review.

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