Variability in intensive care unit length of stay after liver transplant: Determinants and potential opportunities for improvement

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Purpose:Recovery after liver transplant (LT) requires extensive resources, including prolonged intensive care unit stays. The objective of this study was to use an assessment tool to determine if LT recipients remain in ICU beyond designated indications.Methods:Records from 100 consecutive LTs performed in a single institution were retrospectively reviewed. An admission, discharge, and triage screening (ADT) tool was utilized to assess the indications for each ICU day. Data collected included demographics; pre-, intra-, and post-operative course; and complications. Days not meeting ADT criteria were considered additional ICU days.Results:100 patients: mean age 55years (range 24–78years) and mean MELD score 30 (range 6–47). Three recipients who died within one week were excluded. Forty-eight (49.5%) patients had a total of 75 additional days on initial ICU stay. Univariate analysis revealed no significant differences between patients with and without additional days. 12/97 (12.4%) patients returned to ICU including 5/48 and 7/49 with and without additional days.Conclusion:Nearly half of the LT recipients remained in ICU an average of 1.6 additional days. Monitoring of organ function appeared to be the most common reason. Opportunities to improve resource utilization could include transfer to an intermediate/progressive care (“step-down”) unit.HIGHLIGHTSLiver transplant recipients often have prolonged intensive care unit (ICU) stays.An admission, discharge, and triage tool can be used to evaluate need for ICU care.Nearly half of liver transplant recipients had potentially avoidable ICU days.Monitoring of organ function was the most common reason for additional ICU days.Intermediate care units can improve resource utilization by decreasing ICU stay.

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