Hospitalization costs and their determining factors among patients undergoing kidney transplantation: a cross-sectional descriptive study

ABSTRACT BACKGROUND: Cost evaluation is a key tool in monitoring expenditure for budget management. It increases the efficiency of possible changes through identifying potential savings and estimating the resources required to make such changes. However, there is a lack of knowledge of the total cost of hospitalization up to the clinical outcome, regarding patients admitted for kidney transplantation. Likewise, there is a lack of data on the factors that influence the amounts spent by hospital institutions and healthcare systems. OBJECTIVES: To describe the costs and determining factors relating to hospitalization of patients undergoing kidney transplantation. DESIGN AND SETTING: Cross-sectional descriptive study with a quantitative approach based on secondary data from 81 patients who were admitted for kidney transplantation at a leading transplantation center in southern Brazil. METHODS: The direct costs of healthcare for patients who underwent kidney transplantation were the dependent variable, and included personnel, expenses, third-party services, materials and medicines. The factors that interfered in the cost of the procedure were indirect variables. The items that made up these variables were gathered from the records of the internal transplantation committee and from the electronic medical records. The billing sector provided information on the direct costs per patient. RESULTS: The estimated total cost of patients' hospitalization was R$ 1,257,639.11 (US$ 571,010.44). Out of this amount, R$ 1,237,338.31 (US$ 561,793.20) was paid by the Brazilian National Health System and R$ 20,300.80 (US$ 9,217.24) by the transplantation center's own resources. The highest costs related to the length of hospital stay and clinical complications such as sepsis and pneumonia. CONCLUSIONS: The costs of hospitalization for kidney transplantation relate to the length of hospital stay and clinical complications.

Liver Transplantation in Patients over Sixty Years of Age

PURPOSE: Orthotopic liver transplantation is considered a standard procedure for patients with end-stage liver disease. Liver transplantation in older patients has increased, with generally acceptable results. In Korea we have an aging population. In this study, we retrospectively reviewed the results of liver transplantation in patients more than 60 years of age at Asan Medical Center. METHODS: Fifty-four patients, age 60 and over, received a liver transplantation at Asan Medical Center between January 1998 and June 2005. We retrospectively reviewed the medical records of these patients. All patients were assessed according to the following variables: age, gender, clinical features, indications for transplantation, surgical findings, the hospital stay following liver transplantation, days in the intensive care unit, complications, and survival. RESULTS: The mean age of the recipients was 62.4 years. The transplant indications were 28 cases of hepatocellular carcinoma and 15 of HBV related cirrhosis. There was postoperative mortality (up to 3 months) in seven patients (13.21%). The mean ICU and hospital stays were 8.04 and 36.8 days, respectively. Overall, the patient survival rates at 1, 3 and 5 years was 83.02%, 75.47% and 75.47%, respectively. CONCLUSIONS: The results of this study showed that chronologic age should not be a contraindication to liver transplantation, especially if the pretransplant evaluation shows no comorbid disease that could increase the mortality rate.