Journal of the American College of Surgeons · 2025
Comprehensive Analysis of a Single-Center Inpatient Posttransplant Physical Therapy Program in High-Acuity Patients: Is It Worth the Effort?
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Ugarte Ramsey, Noguchi Daisuke, Jaeger Cindy, Yu Lowa, Ha Minah, Agopian Vatche G, Farmer Douglas G, Ebaid Samer, Kaldas Fady M
Аннотация
BACKGROUND: High-acuity post-liver transplantation (LT) patients often have a prolonged hospital course. In response, we developed a novel, intensive inpatient group physical therapy (PT) program and sought to evaluate its impact on outcomes.
STUDY DESIGN: All consecutive adult LT recipients at a single center were retrospectively analyzed (August 2013 to July 2021). Comparative and multivariable regression analysis using 131 variables assessed patients who received group PT at a dedicated area of our hospital (GYM) and patients receiving standard PT (NON-GYM). Subset analysis of GYM and NON-GYM patients assessed outcomes for high-acuity patients (Model for End-Stage Liver Disease score of 35 or more, ICU admission before LT, and hospitalization of 60 days or more).
RESULTS: A total of 1,183 consecutive adult LTs were performed during the study period. In all, 302 patients were enrolled in the GYM program. NON-GYM patients had higher rates of in-hospital mortality (6% vs 1%, p < 0.001). Multivariate analysis of the entire cohort identified NON-GYM as a significant independent risk factor for in-hospital mortality (odds ratio 6.543, 95% CI 2.292 to 18.681, p < 0.001) along with preoperative ventilation, coronary artery disease, unplanned reoperation, and reintubation after LT. High-acuity GYM patients were less likely to be reintubated (32% vs 46%, p = 0.048), require postoperative tracheostomy (13% vs 24%, p = 0.038), and had lower in-hospital mortality (1% vs 15%, p < 0.001).
CONCLUSIONS: This analysis suggests that there may be a significant benefit for high-acuity LT patients who undergo intensive inpatient group PT in reducing postoperative reintubation, tracheostomy, and in-hospital mortality.
STUDY DESIGN: All consecutive adult LT recipients at a single center were retrospectively analyzed (August 2013 to July 2021). Comparative and multivariable regression analysis using 131 variables assessed patients who received group PT at a dedicated area of our hospital (GYM) and patients receiving standard PT (NON-GYM). Subset analysis of GYM and NON-GYM patients assessed outcomes for high-acuity patients (Model for End-Stage Liver Disease score of 35 or more, ICU admission before LT, and hospitalization of 60 days or more).
RESULTS: A total of 1,183 consecutive adult LTs were performed during the study period. In all, 302 patients were enrolled in the GYM program. NON-GYM patients had higher rates of in-hospital mortality (6% vs 1%, p < 0.001). Multivariate analysis of the entire cohort identified NON-GYM as a significant independent risk factor for in-hospital mortality (odds ratio 6.543, 95% CI 2.292 to 18.681, p < 0.001) along with preoperative ventilation, coronary artery disease, unplanned reoperation, and reintubation after LT. High-acuity GYM patients were less likely to be reintubated (32% vs 46%, p = 0.048), require postoperative tracheostomy (13% vs 24%, p = 0.038), and had lower in-hospital mortality (1% vs 15%, p < 0.001).
CONCLUSIONS: This analysis suggests that there may be a significant benefit for high-acuity LT patients who undergo intensive inpatient group PT in reducing postoperative reintubation, tracheostomy, and in-hospital mortality.