Association of transplant recipient status with clinical and financial outcomes among patients undergoing major surgery

Muhammad Muntazir Mehdi Khan; Selamawit Woldesenbet; Muhammad Musaab Munir; Mujtaba Khalil; Yutaka Endo; Erryk Katayama; Abdullah Altaf; Zayed Rashid; Austin Schenk; Timothy M Pawlik

doi:10.1016/j.surg.2024.06.086

Association of transplant recipient status with clinical and financial outcomes among patients undergoing major surgery

Surgery. 2024 Nov 27:S0039-6060(24)00914-0. doi: 10.1016/j.surg.2024.06.086. Online ahead of print.

Affiliations

¹ Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH. Electronic address: https://twitter.com/Muntazirmehdik.
² Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
³ Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH. Electronic address: https://twitter.com/Mujtabakhalil.
⁴ Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
⁵ Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH. Electronic address: Tim.Pawlik@osumc.edu.

PMID: 39609216
DOI: 10.1016/j.surg.2024.06.086

Abstract

Background: Transplant recipients undergoing surgery may represent a vulnerable population because of transplant-related comorbidities as well as reliance on immunosuppressive medications. We sought to characterize the association of prior transplant status on postoperative outcomes among patients undergoing major non-transplant-related surgical procedures.

Methods: Data on patients who underwent a major surgical procedure (pneumonectomy, coronary artery bypass graft, abdominal aortic aneurysm repair, Whipple, colectomy) between 2016 and 2020 were obtained from the Nationwide Readmission Database. After balancing the 2 cohorts using entropy balancing, multivariable regression models were used to assess the relationship between post-transplant status and patient outcomes.

Results: Among 1,818,973 patients, 0.45% (n = 8,212) had a history of solid organ transplantation (liver: n = 1,773, 21.6%; heart/lung: n = 1,087, 13.2%; kidney/pancreas: n = 4,891, 59.6%; and multiple: n = 461, 5.6%). In the unmatched cohort, patients who had a history of organ transplant were more likely to be male (64.1% vs 57.7%) and have Medicare insurance (71.7% vs 59.3%) (both P < .001). On multivariable analysis, prior transplant recipient status was associated with higher odds of postoperative complications (odds ratio 1.30, 95% confidence interval 1.22-1.38), 30-day readmission (odds ratio 1.42, 95% confidence interval 1.31-1.54), and in-hospital mortality (odds ratio 1.20, 95% confidence interval 1.03-1.40) (all P < .05). Moreover, organ transplantation was associated with higher index hospitalization costs (14.4% difference, 95% confidence interval 14.1%-14.6%) and 30-day postdischarge costs (16.2% difference, 95% confidence interval 15.3%-17.0%) (both P < .001).

Conclusions: Prior transplant recipient status was associated with adverse clinical and financial outcomes following subsequent major surgery. Prior history of transplant may be an important factor to incorporate into risk stratification of patients undergoing subsequent major surgical procedures.