Diagnosis of morbid obesity may not impact healthcare utilization for orthotopic liver transplantation: A propensity matched study

Table 1 Demographic and hospital characteristics in morbidly obese and non-morbidly obese patients who underwent a liver transplant

	No morbid obesity		Morbid obesity		P-value
	n = 45691		n = 818
Age (mean, CI)	53.23	(52.84, 53.61)	53.33	(52.05, 54.61)	0.87
Gender					0.002
Male	30444	66.64%	435	53.21%
Female	15242	33.36%	383	46.79%
Race					0.002
White	25668	67.81%	544	75.15%
Black	2975	7.86%	32	4.49%
Hispanic	5638	14.90%	127	17.60%
Other	3571	9.43%	20	2.75%
Income (National Quartile)					0.04
Low	9947	22.46%	258	32.30%
Moderate	11190	25.27%	213	26.63%
High	11816	26.69%	167	20.87%
Very high	11324	25.58%	161	20.20%
Type of insurance					0.11
Medicare	11817	25.99%	246	30.10%
Medicaid	6487	14.27%	74	8.99%
Private	24983	54.95%	441	53.93%
Other	2179	4.79%	57	6.97%
Type of hospital					0.95
Rural/urban non-teaching	233	0.51%	< 10	0.48%
Urban teaching	45069	99.49%	814	99.52%
Hospital size					0.25
Small/medium	6492	14.33%	88	10.74%
Large	38809	85.67%	730	89.26%
Hospital region					0.43
Northeast	7865	17.21%	118	14.42%
Midwest	9953	21.78%	206	25.24%
South	15116	33.08%	319	39.02%
West	12757	27.92%	174	21.32%
Admission day					0.02
Week day	34444	75.39%	668	81.72%
Weekend	11247	24.62%	149	18.28%
Modified elixhauser index1					< 0.01
< 3	25123	54.98%	131	16.06%
≥ 3	20568	45.02%	686	83.94%

¹After excluding liver failure and obesity.

Table 2 Complications of patients who underwent a liver transplant

	No morbid obesity		Morbid obesity		P-value
	n = 45691		n = 818
Systemic complications
Any	20546	44.97%	394	48.20%	0.5253
Post LT infection	13308	29.13%	297	36.26%	0.2103
Cardiovascular complication	781	1.71%	25	3.05%	0.3858
Infections, surgical wound	2035	4.45%	35	4.29%	0.9301
Cardiac complications	1972	4.32%	49	6.00%	0.2737
Peripheral vascular complications	152	0.33%	0	0.00%	--
Respiratory complications	481	1.05%	40	4.87%	0.0433
Digestive system complications	95	0.21%	≤ 10	1.12%	0.2376
Other postoperative infection	2035	4.45%	35	4.29%	0.9301
Pulmonary insufficiency following surgery	269	0.59%	≤ 10	0.57%	0.9654
Unspecified intestinal obstruction	145	0.32%	0	0.00%	--
Stroke	149	0.33%	0	0.00%	--
Postoperative shock	69	0.15%	≤ 10	0.57%	0.4556
Post LT complication	9927	21.73%	142	17.40%	0.1441
Technical complications
Any	16044	35.11%	263	32.27%	0.4206
Hepatic artery thrombosis	8940	19.57%	113	13.80%	0.0531
History of exploratory laparotomy exploratory laparotomy	221	0.48%	≤ 10	0.57%	0.8483
Anastomotic leak of biliary tree	1442	3.16%	49	6.00%	0.0837
Perforation of the intestine	148	0.32%	0	0.00%	--
Hemorrhage complicating a procedure	5390	11.80%	58	7.04%	0.0278
Accidental laceration during a procedure	965	2.11%	≤ 10	0.67%	0.0611
Iatrogenic pulmonary embolism and infarction	169	0.37%	20	2.49%	0.0862
Iatrogenic pneumothorax	691	1.51%	≤ 10	1.14%	0.6429
Hematoma	3487	7.63%	65	7.94%	0.8931
Seroma complicating a procedure	74	0.16%	≤ 10	1.15%	0.2145
Disruption of wound	25	0.06%	0	0.00%	--
Disruption of internal operation wound	179	0.39%	0	0.00%	--
Disruption of external operation wound	378	0.83%	20	2.43%	0.1632

Variables are expressed as weighted frequency (percentage) and differences between the groups are analyzed with χ² tests. LT: Liver transplantation.

Table 3 Results of multivariate linear/logistic regression for mortality, length of stay and charges for liver transplantation in study cohort

Outcomes	No morbid obesity	Morbid obesity	Adjusted OR/β-coefficient (95%CI)	P-value
	n = 45691 (%)	n = 818 (%)
Mortality	2407 (5.27%)	39 (4.83%)	0.98 (0.50-1.92)	0.95
Length of stay in days, mean (CI)	20.9 (18.7-23.1)	18.7 (15.5-22)	-3.91 (-7.94-0.14)	0.06
Total charges, mean (CI)	342324 (305778-378870)	378452 (320453-436452)	6121 (-54780-56004)	0.98

¹β-coefficients. Data was adjusted for gender, race, income, modified Elixhauser comorbidity score, weekend admission, and diabetes.

Table 4 Analysis of outcomes in the propensity matched sample

Outcomes	No morbid obesity	Morbid obesity	Adjusted OR/β-coefficient (95%CI)	P-value
	n = 143	n = 143
Mortality	10 (7.04%)	< 10 (4.93%)	0.70 (0.27-1.84)	0.47
Length of stay in days, mean (CI)	24.1 (19.5-28.7)	19.6 (16.8-22.5)	-4.44 (-9.93-1.05)1	0.11
Total charges, mean (CI)	388530 (344027-33033)	395518 (349932-441105)	15693 (-51622-83008)1	0.64

¹β-coefficients.