Healthcare Resource Utilization in Obese Patients With High MELD (≥ 35) Undergoing Liver Transplantation: Presidential Poster Award

Abstract

Introduction: Obese patients have a higher rate of metabolic syndrome and medical comorbidities including renal disease and are likely to incur more cost in the post-transplant period. There is only limited data on transplant related cost and resource utilization in obese patients particularly in those with a high MELD score (≥ 35). Our aim was to analyze the healthcare resource utilization in liver transplant recipients with high BMI and high MELD scores. Methods: Single center retrospective chart review of 1,487 liver transplant recipients from Jan 2006 to Dec 2017 was conducted. We identified 92 patients with a MELD score ≥ 35. Patients were stratified in 3 BMI classes( <30, 30-35(Class I Obesity), and >35(Class II Obesity)). Healthcare resource utilization metrics such as: length of hospital stay (LOS), length of ICU stay, transfusion requirements, number of readmissions within one year of transplantation, use of intravenous antibiotics and need for renal replacement therapy were studied. In addition, we compared the actual costs assigned to the patients by the hospital billing department. The costs were divided into labor cost (direct “face to face time” with the patients and administrative cost related to patient care) and supply cost (drugs, environmental services and supplies for special procedures). Cost data was separated into transplant encounter costs and post-transplant care cost. Results: 40 of 92 (43%) patients were obese (BMI > 30) and among them 14 (35%) had class II obesity. NASH was the most common underlying condition for liver transplantation (p=0.03) in obese patients. Obese patients also tend to have significant medical comorbidities of Diabetes (p=0.03), Hypertension (p= 0.01). Class II obesity is associated with higher total transplant cost ($134K) compared to those with Class I obesity ($111K). The Class II obese patients tend to be readmitted sooner (54.5 days) than non-obese (233.4 days) and Class I patients (108.5 days) after liver transplantation and both the groups were comparable with regard to mortality, length of hospital stays, ICU stay and blood transfusion requirement. Conclusion: Class II obesity is associated with significantly higher transplant related costs in patients with a high (≥ 35) MELD score. Considering higher cost and increased readmission risk in class II obesity, third party reimbursement rate for these high risk patients should be renegotiated.1035 Figure 1 No Caption available.