A Cost-effectiveness Analysis of Biliary Anastomosis with or Without T-tube after Orthotopic Liver Transplantation

Mitsugi Shimoda, Sammy Saab, Marcia Morrisey, R. Mark Ghobrial, Douglas G. Farmer, Pauline Chen, Steven Huy B Han, Rudolph A. Bedford, Leonard I. Goldstein, Paul Martin, Ronald W. Busuttil

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Biliary reconstruction continues to be a major source of morbidity following orthotopic liver transplantation. We wished to determine if choledochocholedochostomy without a T-tube was associated with fewer biliary complications and was less costly than choledochocholedochostomy with a T-tube. A retrospective cohort study of patients who underwent liver transplantation was performed. Patients were stratified into two groups: group I had bile duct reconstruction with T-tube and group II did not have a T-tube. The results were interpreted on an intentionto-treat analysis. We identified 147 adult patients who underwent initial liver transplantation. There were 76 patients in group I and 71 patients in group II. There were no statistical differences between the two groups regarding underlying cause of liver disease, patient age, gender or United Network for Organ Sharing status. As the decision to use a T-tube was made at the time of surgery, the two groups may not be strictly comparable. The mean hospital stay was longer in group I (31.1 ± 27.9d) than in group II (18.8 ± 15.5d) (p=0.001). Biliary complications were statistically more frequent in patients from group I patients (25/76, 32.9%) than in patients from group II (11/71, 15.5%) (p =0.01). There was a trend for the costs associated with diagnostic and therapeutic procedures for the management of biliary complications to be greater for group I than for group II, although this was not statistically significant (p =0.235). Our study suggests choledochocholedochostomy without T-tube reconstruction is the preferred strategy for biliary reconstruction in orthotopic liver transplantation. It is not only associated with fewer biliary complications, but also less costly than using choledochocholedochostomy over a T-tube. Randomized prospective studies are needed to confirm our results.

Original languageEnglish
Pages (from-to)157-161
Number of pages5
JournalAmerican Journal of Transplantation
Volume1
Issue number2
StatePublished - Jul 1 2001
Externally publishedYes

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Liver Transplantation
Cost-Benefit Analysis
Bile Ducts
Liver Diseases
Length of Stay
Cohort Studies
Retrospective Studies
Prospective Studies
Morbidity
Costs and Cost Analysis

Keywords

  • Biliary anastomosis
  • Liver transplantation

ASJC Scopus subject areas

  • Immunology

Cite this

Shimoda, M., Saab, S., Morrisey, M., Ghobrial, R. M., Farmer, D. G., Chen, P., ... Busuttil, R. W. (2001). A Cost-effectiveness Analysis of Biliary Anastomosis with or Without T-tube after Orthotopic Liver Transplantation. American Journal of Transplantation, 1(2), 157-161.

A Cost-effectiveness Analysis of Biliary Anastomosis with or Without T-tube after Orthotopic Liver Transplantation. / Shimoda, Mitsugi; Saab, Sammy; Morrisey, Marcia; Ghobrial, R. Mark; Farmer, Douglas G.; Chen, Pauline; Han, Steven Huy B; Bedford, Rudolph A.; Goldstein, Leonard I.; Martin, Paul; Busuttil, Ronald W.

In: American Journal of Transplantation, Vol. 1, No. 2, 01.07.2001, p. 157-161.

Research output: Contribution to journalArticle

Shimoda, M, Saab, S, Morrisey, M, Ghobrial, RM, Farmer, DG, Chen, P, Han, SHB, Bedford, RA, Goldstein, LI, Martin, P & Busuttil, RW 2001, 'A Cost-effectiveness Analysis of Biliary Anastomosis with or Without T-tube after Orthotopic Liver Transplantation', American Journal of Transplantation, vol. 1, no. 2, pp. 157-161.
Shimoda, Mitsugi ; Saab, Sammy ; Morrisey, Marcia ; Ghobrial, R. Mark ; Farmer, Douglas G. ; Chen, Pauline ; Han, Steven Huy B ; Bedford, Rudolph A. ; Goldstein, Leonard I. ; Martin, Paul ; Busuttil, Ronald W. / A Cost-effectiveness Analysis of Biliary Anastomosis with or Without T-tube after Orthotopic Liver Transplantation. In: American Journal of Transplantation. 2001 ; Vol. 1, No. 2. pp. 157-161.
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abstract = "Biliary reconstruction continues to be a major source of morbidity following orthotopic liver transplantation. We wished to determine if choledochocholedochostomy without a T-tube was associated with fewer biliary complications and was less costly than choledochocholedochostomy with a T-tube. A retrospective cohort study of patients who underwent liver transplantation was performed. Patients were stratified into two groups: group I had bile duct reconstruction with T-tube and group II did not have a T-tube. The results were interpreted on an intentionto-treat analysis. We identified 147 adult patients who underwent initial liver transplantation. There were 76 patients in group I and 71 patients in group II. There were no statistical differences between the two groups regarding underlying cause of liver disease, patient age, gender or United Network for Organ Sharing status. As the decision to use a T-tube was made at the time of surgery, the two groups may not be strictly comparable. The mean hospital stay was longer in group I (31.1 ± 27.9d) than in group II (18.8 ± 15.5d) (p=0.001). Biliary complications were statistically more frequent in patients from group I patients (25/76, 32.9{\%}) than in patients from group II (11/71, 15.5{\%}) (p =0.01). There was a trend for the costs associated with diagnostic and therapeutic procedures for the management of biliary complications to be greater for group I than for group II, although this was not statistically significant (p =0.235). Our study suggests choledochocholedochostomy without T-tube reconstruction is the preferred strategy for biliary reconstruction in orthotopic liver transplantation. It is not only associated with fewer biliary complications, but also less costly than using choledochocholedochostomy over a T-tube. Randomized prospective studies are needed to confirm our results.",
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