Impact of the New Kidney Allocation System on Perioperative Outcomes and Costs in Kidney Transplantation.

Abstract:

BACKGROUND:In December 2014, a new kidney allocation system (KAS) was implemented nationwide with the goal of improving longevity matching, increasing access to sensitized patients, and improving racial/ethnic disparities. STUDY DESIGN:National cohort study of US kidney transplantation programs, analyzing hospital-level outcomes (October 2012 to June 2016) using University HealthSystem Consortium data. In-hospital outcomes and costs were analyzed for trends over time using interrupted time series analysis with segmented regression. RESULTS:There were 38,016 kidney transplantation procedures analyzed during the 3.8-year period. Over time, there was a mean increase of 2.7 cases/month (95% CI -0.02 to 5.4; p = 0.059), unaffected by KAS (18.9 case increase; p = 0.5601). Implementation of KAS led to significant changes in patient demographics, including a decrease in age (-2.8 years; p < 0.001), increase in number of African Americans (3.8%; p < 0.001), decrease in number of Caucasians (6.0%; p < 0.001), increase in number of Hispanics (2.9%; p < 0.001), increase in congestive heart failure (1.3%; p < 0.001), and decrease in diabetes with complications (4.0%; p < 0.001). The KAS had no impact on length of stay (0.12 days; 95% CI -0.11 to 0.35), length of stay index (0.01; 95% CI -0.03 to 0.05), ICU cases, ICU length of stay, patient safety indicators, or in-hospital mortality. The KAS led to a significant increase in delayed graft function rates (5.4%; 95% CI 23.3% to 7.4%); total in-hospital costs ($2,429; 95% CI $594 to $4.263); and 7-day (2.2%), 14-day (2.6%), and 30-day (2.7%) readmission rates. CONCLUSIONS:Policy changes in organ allocation can have a significant impact on perioperative costs and outcomes, which can have a downstream influence on transplantation center perisurgical care processes.

journal_name

J Am Coll Surg

authors

Taber DJ,DuBay D,McGillicuddy JW,Nadig S,Bratton CF,Chavin KD,Baliga PK

doi

10.1016/j.jamcollsurg.2016.12.009

subject

Has Abstract

pub_date

2017-04-01 00:00:00

pages

585-592

issue

4

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(16)31700-8

journal_volume

224

pub_type

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