Abstract Rationale Lung transplantation is the cornerstone intervention for patients with end-stage lung disease; however, there is little research examining recent temporal trends in hospitalization outcomes for lung transplant recipients after their index transplant admission. We investigated temporal trends of hospitalization outcomes for lung transplant recipients using a national database, focusing on the relationship between severity of illness and hospital mortality. Methods We used the Healthcare Cost Utilization Project (HCUP) national inpatient sample (NIS) from 2016 to 2020 (1). We included all non-elective hospitalizations of adults (age 18 years or older) who were lung transplant recipients, identified by International Classification of Disease - tenth revision (ICD-10) codes indicating lung transplant status. We excluded initial transplant hospitalizations, identified using ICD-10 procedure codes for single or bilateral lung transplant. We developed a logistic regression model for in-hospital mortality adjusting for patient-level (age, sex, race, Elixhauser comorbidity score, and administrative sequential organ failure assessment SOFA score) and hospital-level (hospital size, location, and teaching status) factors. Our model used regional divisions closely aligned to the organ procurement divisions for the hospital location. Results We identified 15,408 hospitalizations between 2016 to 2020. The unadjusted in-hospital mortality rate was 4.2%, reaching up to 50% in those with administrative SOFA scores of 4 or higher. In the fully adjusted logistic regression model, female sex (OR 1.29 95% CI 1.07-1.55), higher administrative SOFA score (OR 2.17 95% CI 1.98 - 2.38), invasive mechanical ventilation (OR 7.28 95% CI 5.92 - 8.95), and dialysis use (OR 1.65 95% CI 1.25 - 2.18) were associated with increased mortality. Compared with 2016, years 2018 through 2020 had a lower adjusted odds of mortality (p 0.05). The Mid-Atlantic region had high risk-adjusted mortality compared to the reference of the South Atlantic region (Figure). Conclusions Hospital mortality was 4.2% for hospitalizations after initial transplant.. Higher SOFA scores, invasive mechanical ventilation and dialysis are predictors of high mortality for non-index hospitalizations. Future studies should focus on whether there are modifiable factors or practice patterns that could explain the difference in outcomes across different regions. This abstract is funded by: None
Wick et al. (Fri,) studied this question.