Decoding risk factors for prolonged hospitalization after take-back to the operating room after liver transplantation: Escalating costs and clinical implications

Abstract

Background: Despite advances in liver transplantation, unplanned take-back to the operating room remains a significant challenge. This study aimed to identify characteristics associated with take-back procedures, determine predictors of extended length of stay after take-back, and evaluated associated health care costs.

Methods: In this single-center retrospective study of 914 adult liver transplantation recipients (2016-2023), extended length of stay was defined as hospitalization exceeding the 75th percentile (>19 days) among patients requiring take-back. Multivariate analysis identified predictors of prolonged length of stay, and comprehensive cost analysis quantified health care expenditures between cohorts.

Results: Take-back occurred in 12.7% (n = 116) of recipients, with postoperative bleeding/hematoma being the primary indication (67.2%). Patients requiring take-back demonstrated greater median Model for End-Stage Liver Disease including sodium scores (25 vs 22, P = .041), increased rates of pretransplant transjugular intrahepatic portosystemic shunt (15.5% vs 6.8%, P = .002), and more frequent female-to-male donor-recipient matching (30.2% vs 17.7%, P = .01). Among take-back cases, multivariate analysis identified Model for End-Stage Liver Disease including sodium score (odds ratio, 1.08; 95% confidence interval, 1.01-1.16, P = .02) and operating time (odds ratio, 1.62; 95% confidence interval, 1.18-2.21, P = .001) as independent predictors of extended length of stay. Take-back was associated with greater in-hospital costs per case (median [interquartile range], $199,438 [$170,710-$257,159] vs $155,780 [$135,476-$181,953], P < .001).

Conclusion: This study identified distinct characteristics associated with take-back to the operating room after liver transplantation and demonstrated that elevated Model for End-Stage Liver Disease including sodium scores and extended operating time independently predict prolonged length of stay after reoperation. The substantial cost differential associated with take-back procedures highlights the economic impact of this complication. These readily available clinical parameters enable practical risk stratification for extended hospitalization, facilitating more effective resource planning and optimization of health care resource allocation.