Predictive Factors of Intensive Care Length of Stay in Liver Transplant Recipients

Abstract

The purpose of this study was to evaluate liver transplant recipient factors associated with postoperative complications leading to longer intensive care unit (ICU) length of stay which in turn may increase hospital morbidity and mortality. A retrospective, correlational design was developed with a sample of 230 participants. Data were collected for liver transplant recipients over a four-year period (June 2007-December 2011) from the electronic medical record and the transplant database. T test and binary logistic regression were used to assess for the factors predictive of ICU complications, ICU length of stay (LOS), hospital length of stay (HLOS), and overall morbidity and mortality. Data were collected from three time periods: preoperatively, intraoperatively, and postoperatively. The factors identified as statistically significant were cold ischemic time, lowest intraoperative glucose, postoperative four-hour blood urea nitrogen (BUN), Postoperative Day 1 (POD 1) hematocrit, postoperative lowest systolic blood pressure, and fresh frozen plasma (FFP) transfusions. Mortality occurred in 1 recipient in the >9-day ICU stay group, and 7 deaths were noted in the >19-day hospital LOS group. Age of recipients who died was 48-59 (6 males, 2 females), with 7 Caucasian and 1 Other. Comorbidities of these deceased recipients were diabetes and obesity with MELD scores of 18-45. Complications experienced by recipients included: 6 with renal failure, 2 with sepsis, 3 with graft dysfunction, and 1 with cerebral edema. Findings from this study showed factors that impact ICU LOS, HLOS, and mortality, including BUN, glucose, and hematocrit. Implications for practice are that these factors should be closely monitored in the pre-, intra-, and postoperative time periods to reduce risks of complications to transplant recipients. Future research should include further evaluation of the factors associated with poor transplant outcomes, including glucose, continuous renal replacement therapy (CRRT) use, age, and gender. Nurse researchers must continue to strive to understand the pathophysiological mechanism of liver disease to reduce ICU complications ultimately to improve the care and outcomes of liver transplant recipients while reducing ICU LOS and HLOS.