Journal article
The effect of lung size mismatch on complications and resource utilization after bilateral lung transplantation
The Journal of heart and lung transplantation, Vol.31(5), pp.492-500
05/2012
DOI: 10.1016/j.healun.2011.12.009
PMID: 22325691
Abstract
Oversizing the lung allograft, as estimated by a donor-to-recipient predicted total lung capacity (pTLC) ratio > 1.0, was associated with improved long-term survival after lung transplantation (LTx) but could be associated with increased post-operative complications and higher resource utilization.
The prospectively maintained LTx database at The Johns Hopkins Hospital was retrospectively reviewed for bilateral LTx patients in the post-Lung Allocation Score (LAS) era. Patients were grouped by pTLC ratio ≤ 1.0 (undersized) or > 1.0 (oversized). Post-operative complications and hospital charges were analyzed.
The pTLC ratio was available for 70 patients: 31 were undersized and 39 oversized. Undersized patients had a higher LAS (40.4 vs 35.8, p = 0.009), were more often in the intensive care unit (ICU) pre-LTx (35% vs 10%, p = 0.01), and had a higher occurrence of primary graft dysfunction (PGD; 25% vs 5%, p = 0.013) and tracheostomy (32% vs 10%, p = 0.02), longer index hospitalizations (20 [interquartile range (IQR), 10–46] vs 16 [IQR, 12–25] days, p = 0.048), and higher index hospitalization charges ($176,247 [IQR, $137,646–$284,012] vs $158,492 [IQR, $136,250–$191,301], p = 0.04). After adjusting for LAS and pre-LTx ICU stay, a lower pTLC ratio remained associated with higher hospital charges (p = 0.049). Airway complications were more frequent and severe in undersized patients.
Oversized allografts were not associated with an increase in post-LTx complications. However, LTx recipients of undersized allografts were more likely to experience PGD, tracheostomy, and had higher resource utilization. Higher acuity in the undersized group might explain these findings; however, multivariate models suggest an independent association between undersizing, PGD, and resource utilization.
Details
- Title: Subtitle
- The effect of lung size mismatch on complications and resource utilization after bilateral lung transplantation
- Creators
- Michael Eberlein - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandGeorge J Arnaoutakis - Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MarylandLonny Yarmus - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandDavid Feller-Kopman - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandRebecca Dezube - Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandMayy F Chahla - Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandServet Bolukbas - Department of Thoracic Surgery, Dr.-Horst-Schmidt-Klinik, Wiesbaden, GermanyRobert M Reed - Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, MarylandJulia Klesney-Tait - University of Iowa Hospitals and Clinics, Iowa City, IowaKalpaj R Parekh - University of Iowa Hospitals and Clinics, Iowa City, IowaChristian A Merlo - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandAshish S Shah - Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MarylandJonathan B Orens - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandRoy G Brower - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Resource Type
- Journal article
- Publication Details
- The Journal of heart and lung transplantation, Vol.31(5), pp.492-500
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.healun.2011.12.009
- PMID
- 22325691
- ISSN
- 1053-2498
- eISSN
- 1557-3117
- Language
- English
- Date published
- 05/2012
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Anatomy and Cell Biology; Surgery; General Internal Medicine; Cardiothoracic Surgery; Internal Medicine
- Record Identifier
- 9984025444502771
Metrics
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