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Clinical and financial outcomes of transplant recipients following emergency general surgery operations()

INTRODUCTION: Due to immunosuppression and underlying comorbidities, transplant recipients represent a vulnerable population following emergency general surgery (EGS) operations. The present study sought to evaluate clinical and financial outcomes of transplant patients undergoing EGS. METHODS: The...

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Autores principales: Tran, Zachary, Lee, Jonathan, Richardson, Shannon, Bakhtiyar, Syed Shahyan, Shields, Lauren, Benharash, Peyman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10149279/
https://www.ncbi.nlm.nih.gov/pubmed/37131533
http://dx.doi.org/10.1016/j.sopen.2023.04.002
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author Tran, Zachary
Lee, Jonathan
Richardson, Shannon
Bakhtiyar, Syed Shahyan
Shields, Lauren
Benharash, Peyman
author_facet Tran, Zachary
Lee, Jonathan
Richardson, Shannon
Bakhtiyar, Syed Shahyan
Shields, Lauren
Benharash, Peyman
author_sort Tran, Zachary
collection PubMed
description INTRODUCTION: Due to immunosuppression and underlying comorbidities, transplant recipients represent a vulnerable population following emergency general surgery (EGS) operations. The present study sought to evaluate clinical and financial outcomes of transplant patients undergoing EGS. METHODS: The 2010–2020 Nationwide Readmissions Database was queried for adults (≥18 years) with non-elective EGS. Operations included bowel resection, perforated ulcer repair, cholecystectomy, appendectomy and lysis of adhesions. Patients were classified by transplant history (Non-transplant, Kidney/Pancreas, Liver, Heart/Lung). The primary outcome was in-hospital mortality while perioperative complications, resource utilization and readmissions were secondarily considered. Multivariable regression models evaluated the association of transplant status on outcomes. Entropy balancing was employed to obtain a weighted comparison to adjust for intergroup differences. RESULTS: Of 7,914,815 patients undergoing EGS, 25,278 (0.32 %) had prior transplantation. The incidence of transplant patients increased temporally (2010: 0.23 %, 2020: 0.36 %, p < 0.001) with Kidney/Pancreas comprising the largest proportion (63.5 %). Non-transplant more frequently underwent appendectomy and cholecystectomy while transplant patients more commonly received bowel resections. Following entropy balancing, Liver was associated with decreased odds of mortality (AOR: 0.67, 95 % CI: 0.54–0.83, Reference: Non-transplant). Incremental hospitalization duration was longer in Liver and Heart/Lung compared to Non-transplant. Odds of acute kidney injury, readmissions and costs were higher in all transplant types. CONCLUSION: The incidence of transplant recipients undergoing EGS operations has increased. Liver was observed to have lower mortality compared to Non-transplant. Transplant recipient status, regardless of organ, was associated with greater resource utilization and non-elective readmissions. Multidisciplinary care coordination is warranted to mitigate outcomes in this high-risk population.
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spelling pubmed-101492792023-05-01 Clinical and financial outcomes of transplant recipients following emergency general surgery operations() Tran, Zachary Lee, Jonathan Richardson, Shannon Bakhtiyar, Syed Shahyan Shields, Lauren Benharash, Peyman Surg Open Sci Research Paper INTRODUCTION: Due to immunosuppression and underlying comorbidities, transplant recipients represent a vulnerable population following emergency general surgery (EGS) operations. The present study sought to evaluate clinical and financial outcomes of transplant patients undergoing EGS. METHODS: The 2010–2020 Nationwide Readmissions Database was queried for adults (≥18 years) with non-elective EGS. Operations included bowel resection, perforated ulcer repair, cholecystectomy, appendectomy and lysis of adhesions. Patients were classified by transplant history (Non-transplant, Kidney/Pancreas, Liver, Heart/Lung). The primary outcome was in-hospital mortality while perioperative complications, resource utilization and readmissions were secondarily considered. Multivariable regression models evaluated the association of transplant status on outcomes. Entropy balancing was employed to obtain a weighted comparison to adjust for intergroup differences. RESULTS: Of 7,914,815 patients undergoing EGS, 25,278 (0.32 %) had prior transplantation. The incidence of transplant patients increased temporally (2010: 0.23 %, 2020: 0.36 %, p < 0.001) with Kidney/Pancreas comprising the largest proportion (63.5 %). Non-transplant more frequently underwent appendectomy and cholecystectomy while transplant patients more commonly received bowel resections. Following entropy balancing, Liver was associated with decreased odds of mortality (AOR: 0.67, 95 % CI: 0.54–0.83, Reference: Non-transplant). Incremental hospitalization duration was longer in Liver and Heart/Lung compared to Non-transplant. Odds of acute kidney injury, readmissions and costs were higher in all transplant types. CONCLUSION: The incidence of transplant recipients undergoing EGS operations has increased. Liver was observed to have lower mortality compared to Non-transplant. Transplant recipient status, regardless of organ, was associated with greater resource utilization and non-elective readmissions. Multidisciplinary care coordination is warranted to mitigate outcomes in this high-risk population. Elsevier 2023-04-15 /pmc/articles/PMC10149279/ /pubmed/37131533 http://dx.doi.org/10.1016/j.sopen.2023.04.002 Text en © 2023 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Research Paper
Tran, Zachary
Lee, Jonathan
Richardson, Shannon
Bakhtiyar, Syed Shahyan
Shields, Lauren
Benharash, Peyman
Clinical and financial outcomes of transplant recipients following emergency general surgery operations()
title Clinical and financial outcomes of transplant recipients following emergency general surgery operations()
title_full Clinical and financial outcomes of transplant recipients following emergency general surgery operations()
title_fullStr Clinical and financial outcomes of transplant recipients following emergency general surgery operations()
title_full_unstemmed Clinical and financial outcomes of transplant recipients following emergency general surgery operations()
title_short Clinical and financial outcomes of transplant recipients following emergency general surgery operations()
title_sort clinical and financial outcomes of transplant recipients following emergency general surgery operations()
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10149279/
https://www.ncbi.nlm.nih.gov/pubmed/37131533
http://dx.doi.org/10.1016/j.sopen.2023.04.002
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