Healthcare Contact Days Pre- and Post-Liver Transplant in Patients with Cirrhosis: A National Cohort Study.

Abstract

Introduction: "Healthcare contact days" is a patient-centered quantitative proxy for time toxicity, which can be informative for liver transplant (LT) decision-making. We aimed to (i) quantify contact days in patients with cirrhosis pre- and post-LT; (ii) identify clinical and demographic features associated with contact days.

Methods: Using a national health system database, we calculated healthcare contact days (inpatient, outpatient hospital [e.g. observation], ambulatory, emergency, mental health, other) for patients with cirrhosis before and after LT.

Results: Between 2008-2023, 2,708 patients underwent LT (median age 59[IQR 52-65], 66% male, 68% non-Hispanic white). Total mean contact days were 76.0(SD,58.6) 1-year pre-LT, increasing to 92.3(SD,63.2) 1-year post-LT, then decreasing to 39.7(SD,43.3) and 30.9(SD,35.6) 2- and 3-years post-LT, respectively. Mean inpatient contact days were 33.6(SD,47.5) 1-year pre-LT, increasing to 49.6(SD,59.1) 1-year post-LT, then decreasing to 11.9(SD,32.0) and 6.7(SD,19.8) 2- and 3-years post-LT, respectively. In multivariable analysis, pre-LT contact days were not associated with post-LT days (incidence rate ratio [IRR] 1.00[1.00-1.00]). Post-LT, female gender (IRR 1.09[1.03-1.15]), Black race (IRR 1.11[1.00-1.23]), and pre-LT dialysis (IRR 1.21[1.10-1.34]) were associated with increased total contact days.

Discussion: Healthcare contact days provide interpretable prognostic information to inform expectations regarding LT for cirrhosis, and can be useful for patients, providers, and policymakers alike.