Background: Liver transplantation has increased in volume and provides substantial survival benefit. However, there remains a need for value-based assessment of this costly procedure.
Methods: Model for end stage liver disease era adult recipients were identified using United Network for Organ Sharing Standard Transplant Analysis file data (n = 75,988) and compared across time periods (period A: February 2002 to January 2007; B: February 2007 to January 2013; C: February 2013 to January 2019). Liver centers were divided into volume tertiles for each period (small, medium, large). Value for the index transplant episode was defined as percentage graft survival ≥1 year divided by mean posttransplant duration of stay.
Results: All centers increased value over time due to ubiquitous improvement in 1-year graft survival. However, large centers demonstrated the most significant value change (large +17% vs small +7.0%, P < .001) due to a -8.5% reduction in large centers duration of stay from period A to C, while small centers duration of stay remained unchanged (-0.1%). Large centers delivered higher value despite more complex care: older recipients (54.8 ± 10.3 vs 53.0 ± 11.4 years P < .001), fewer model for end stage liver disease exceptions (34.0% vs 38.2%, P < .001), higher rates of candidate portal vein thrombosis (10.1% vs 8.5%, P < .001) and prior abdominal surgery (43.4% vs 37.4%, P < .001), and more marginal donor utilization (donor risk index 1.45 ± 0.38 vs 1.36 ± 0.33, P < .001). Mahalanobis metric matching demonstrated that compared with small centers, large centers progressively shortened recipient duration of stay per transplant in each period (A: -0.36 days, P = .437; B: -2.14 days, P < .001; C: -2.49 days, P < .001).
Conclusion: There is value in liver transplant volume. Adoption of value-based practices from large centers may allow optimization of health care delivery for this costly procedure.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.surg.2022.05.001 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Evaluating the impact of modeling choices on the performance of integrated genetic and clinical models.
Genet Med
December 2024
Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN; Center for Digital Genomic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN. Electronic address:
Purpose: The value of genetic information for improving the performance of clinical risk prediction models has yielded variable conclusions. Many methodological decisions have the potential to contribute to differential results. We performed multiple modeling experiments integrating clinical and demographic data from electronic health records (EHR) with genetic data to understand which decisions may affect performance.
View Article and Find Full Text PDFSwallowing, speech and voice impairments in head and neck cancer patients treated at a multidisciplinary integrated patient unit.
Int J Lang Commun Disord
December 2024
Hearing, Speech & Language Center, Sheba Medical Center, Tel Hashomer, Israel.
Background: Head and neck cancer (HNC) is amongst the 10 most common cancers worldwide and has a major effect on patients' quality of life. Given the complexity of this unique group of patients, a multidisciplinary team approach is preferable. Amongst the debilitating sequels of HNC and/or its treatment, swallowing, speech and voice impairments are prevalent and require the involvement of speech-language pathologists (SLPs).
View Article and Find Full Text PDFInactivation of the SLC25A1 gene during embryogenesis induces a unique senescence program controlled by p53.
Cell Death Differ
December 2024
Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, D.C., USA.
Germline inactivating mutations of the SLC25A1 gene contribute to various human disorders, including Velocardiofacial (VCFS), DiGeorge (DGS) syndromes and combined D/L-2-hydroxyglutaric aciduria (D/L-2HGA), a severe systemic disease characterized by the accumulation of 2-hydroxyglutaric acid (2HG). The mechanisms by which SLC25A1 loss leads to these syndromes remain largely unclear. Here, we describe a mouse model of SLC25A1 deficiency that mimics human VCFS/DGS and D/L-2HGA.
View Article and Find Full Text PDFPerceived effects of health status on sexual activity in patients with axial spondyloarthritis: a 5-year follow-up study.
Rheumatol Int
December 2024
Division of Rheumatology, Department of Internal Medicine, Sorlandet Hospital, Kristiansand, Norway.
Axial spondyloarthritis (ax-SpA) causes pain, fatigue, stiffness, loss of physical function, and poor health status, which can influence sexual activity and enjoyment. To explore whether patients with ax-SpA perceive that their health status effects their sexual activity and to identify predictors of these perceived effects on sexual activity after a 5-year follow-up. Data about demographics, disease, medication, health-related quality of life (HRQOL), and sexual quality of life (SQOL) were collected at the baseline and 5-year follow-up.
View Article and Find Full Text PDFExpression and purification of recombinant tilapia lake virus segment 4 protein and its in-vitro biological activity for potential use in vaccine development.
Sci Rep
December 2024
Department of Biotechnology, Faculty of Agro-industry, Kasetsart University, Bangkok, 10900, Thailand.
Tilapia lake virus (TiLV) disease is highly contagious and causes substantial mortality in tilapia. Currently, no effective treatments or commercial vaccines are available to prevent TiLV infection. In this study, TiLV segment 4 (S4) was cloned into the pET28a(+)vector and transformed into Escherichia coli BL21(DE3).
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!