• Audrey E Ertel, Koffi Wima, Alex L Chang, Richard S Hoehn, Samual F Hohmann, Michael J Edwards, Daniel E Abbott, and Shimul A Shah.
• Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Cincinnati, OH; Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
• J. Am. Coll. Surg. 2016 Apr 1; 222 (4): 419-28.

BackgroundThe rate and consequences of reoperation after liver transplantation (LT) are unknown in the United States.Study DesignAdult patients (n = 10,295; 45% of all LT) undergoing LT from 2009 through 2012 were examined using a linkage of the University HealthSystem Consortium and Scientific Registry of Transplant Recipients databases providing recipient, donor, center, hospitalization, and survival details. Median follow-up was 2 years. Reoperations were identified within 90 days after LT.ResultsOverall 90-day reoperation rate after LT was 29.3%. Risk factors for 90-day reoperation included recipients with a history of hemodialysis, severely ill functional status, government insurance, increasing Model for End-Stage Liver Disease score, and increasing donor risk index. Reoperation within 90 days was found to be an independent predictor of adjusted 1-year mortality (odds ratio = 1.8; 95% CI, 1.5-2.1), as was government-provided insurance and increasing donor risk index. Additionally, patients undergoing delayed reoperative intervention (after 30 days) were found to have increased risk of 1-year mortality compared with those undergoing early reoperative intervention (odds ratio = 1.96; 95% CI, 1.4-2.7; p < 0.01).ConclusionsThis is the first national study reporting that nearly one-third of transplant recipients undergo reoperation within 90 days of LT. Although necessary at times, reoperation is associated with increased risk of death at 1 year; however, it appears that the timing of these interventions can be critical, due to the type of intervention required. Early reoperative intervention does not appear to influence long-term outcomes, and delayed intervention (after 30 days) is strongly associated with decreased survival.Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

47 keywords...

hide…