R Cutler Quillin1, Gregory C Wilson1, Koffi Wima1, Samuel F Hohmann2, Jeffrey M Sutton1, Joshua J Shaw1, Ian M Paquette1, E Steve Woodle1, Daniel E Abbott1, Shimul A Shah3. 1. Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio. 2. University Health Consortium and Department Health Systems Management, Rush University, Chicago, Illinois. 3. Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio. Electronic address: shimul.shah@uc.edu.
Abstract
BACKGROUND & AIMS: Previous studies have reported that patients of higher socioeconomic status (SES) have increased access to liver transplantation and reduced waitlist mortality than patients of lower SES. However, little is known about the association between SES and outcomes after liver transplantation. METHODS: By using a link between the University HealthSystem Consortium and the Scientific Registry of Transplant Recipients databases, we identified 12,445 patients who underwent liver transplantation from 2007 through 2011. We used a proportional hazards model to assess the effect of SES on patient survival, controlling for characteristics of recipients, donors, geography, and center. RESULTS: Compared with liver recipients in the lowest SES quintile, those in the highest quintile were more likely to be male, Caucasian, have private insurance, and undergo transplantation when they had lower Model for End-Stage Liver Disease scores. In proportional hazards model analysis, liver recipients of the lowest SES were at an increased risk for death within a median of 2 years after transplantation (hazard ratio, 1.17; 95% confidence interval, 1.02-1.35). CONCLUSIONS: Patients of lower SES appear to face barriers to liver transplantation, but perioperative outcomes (length of stay, in-hospital mortality, or 30-day readmission) do not differ significantly from those of patients of higher SES. However, fewer patients of low SES survive for 2 years after transplantation, independent of features of the recipient, donor, surgery center, or location.
BACKGROUND & AIMS: Previous studies have reported that patients of higher socioeconomic status (SES) have increased access to liver transplantation and reduced waitlist mortality than patients of lower SES. However, little is known about the association between SES and outcomes after liver transplantation. METHODS: By using a link between the University HealthSystem Consortium and the Scientific Registry of Transplant Recipients databases, we identified 12,445 patients who underwent liver transplantation from 2007 through 2011. We used a proportional hazards model to assess the effect of SES on patient survival, controlling for characteristics of recipients, donors, geography, and center. RESULTS: Compared with liver recipients in the lowest SES quintile, those in the highest quintile were more likely to be male, Caucasian, have private insurance, and undergo transplantation when they had lower Model for End-Stage Liver Disease scores. In proportional hazards model analysis, liver recipients of the lowest SES were at an increased risk for death within a median of 2 years after transplantation (hazard ratio, 1.17; 95% confidence interval, 1.02-1.35). CONCLUSIONS:Patients of lower SES appear to face barriers to liver transplantation, but perioperative outcomes (length of stay, in-hospital mortality, or 30-day readmission) do not differ significantly from those of patients of higher SES. However, fewer patients of low SES survive for 2 years after transplantation, independent of features of the recipient, donor, surgery center, or location.
Authors: Richard S Hoehn; Dennis J Hanseman; Alex L Chang; Megan C Daly; Audrey E Ertel; Daniel E Abbott; Shimul A Shah; Ian M Paquette Journal: J Gastrointest Surg Date: 2016-09-01 Impact factor: 3.452
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Authors: W Li; L Stocchi; D Cherla; G Liu; A Agostinelli; C P Delaney; S R Steele; E Gorgun Journal: Tech Coloproctol Date: 2017-08-17 Impact factor: 3.781
Authors: Young Kim; Alex L Chang; Koffi Wima; Audrey E Ertel; Tayyab S Diwan; Daniel E Abbott; Shimul A Shah Journal: Surgery Date: 2016-08-26 Impact factor: 3.982
Authors: Sharad I Wadhwani; Andrew F Beck; John Bucuvalas; Laura Gottlieb; Uma Kotagal; Jennifer C Lai Journal: Am J Transplant Date: 2020-02-06 Impact factor: 8.086