Piggyback Technique for Liver Transplants Can Reduce Cost without Compromising Outcome
Abstracts
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Introduction: Liver transplantation continues to be one of the most expensive treatment options in medicine. Transplant surgeons must reduce costs where possible without compromising patient care. We previously reported that choice of surgical technique can impact on resource utilization in liver transplantation with conversion from conventional venovenous bypass (VVB) to the piggyback (PB) technique. Here we extend our findings to a large single center experience with PB technique. Methods: We retrospectively analyzed perioperative data for 160 patients (PB n=75, VVB n=85). Results: The two groups were not statistically different with respect to recipients sex, age, pre-operative diagnosis, Child-Pugh Score, UNOS status, serum creatinine, history of previous abdominal surgery, donor age or graft cold ischemia time. Analysis of intraoperative events revealed a reduction in the length of surgery for the PB group (438+/-107 min. v. 497+/-100 min., p<0.01), and a greater than 50% reduction in the duration of the anhepatic phase (52+/-27 min. v. 122+/-55 min., p<0.01). Amounts of red blood cells (banked blood and cell saver) and fresh frozen plasma transfused were also reduced (RBC: 8.7+/-7.0 units v. 13.4+/-11.9 units, p<0.01; FFP: 5.1+/-4.4 units v. 8.2+/-6.5 units, p<0.01). Although there was no significant difference in mean arterial blood pressures during the anhepatic phase (80+/-11 mmHg v. 79+/-13.4 mmHg, p=NS) and in the period immediately after reperfusion (75+/-13 mmHg v. 75+/-15 mmHg, p=NS), the PB technique produced less hypothermia (35.5+/-1.1 oC v. 35.0+/-1.1 oC, p<0.01). Post-operative hospital stay was not statistically different (12.0+/-6.0 days v. 13.3+/-6.3 days), yet there was a trend toward decreased length of stay in the intensive care unit (PB 3.3+/-2.8 days v. VVB 4.2+/-3.4 days, p=0.09). Total charges were significantly reduced by use of PB technique, with a decrease in total cost of over ,000. (. v. ., p=0.014). There was no difference in one-year actuarial patient or graft survival (91% v. 96%, p=NS), nor development of post-transplant ascites (4% v. 5%, p=NS). Conclusion: The piggyback technique can safely be used to reduce hospital expenses. Surgical choices in liver transplantation can affect resource utilization without impacting patient care. |