Abstract Rationale The COVID-19 era introduced additional indications for lung transplantation including post-COVID pulmonary fibrosis (PF) and acute respiratory distress syndrome (ARDS) while also illustrating systemic healthcare strain. When the pandemic first struck the number of transplant recipients decreased with increasing waitlist mortality which finally reversed in 2022. Registry studies had shown that 1-year post-transplant survival before and after the COVID pandemic remained stable, however comparison of outcomes and hospital resource utilization in the perioperative period has been underexplored. This study aims to perform these comparisons using a comprehensive national dataset. Methods We analyzed the National Inpatient Sample from 2016-2022, identifying adults who underwent only lung transplantation using International Classification of Diseases, Tenth Revision procedure codes. Primary outcomes included changes in all-cause in-hospital mortality, length of stay, and total hospital charges before and after COVID. Multivariable logistic and linear regression was performed, adjusting for age, sex, race, insurance type, household income, Elixhauser comorbidity index, and hospital variables including bed size, region, and teach status. Secondary analysis looked into post-COVID PF and ARDS as additional covariates to determine whether these indications accounted for COVID-era changes. Results Out of 3, 440 adult lung transplantations, 1, 921 occurred before COVID (2016-2019) and 1, 519 occurred post-COVID (2020-2022). Compared to the pre-COVID era, the COVID era was associated with longer hospitalizations (median 23 vs 21 days, p 0. 05) and higher total charges (893, 000 vs 660, 000, p 0. 05) while in-hospital mortality remained similar (5. 2% vs 3. 9%, p 0. 05). In the COVID era, the indications post-COVID PF and ARDS independently predicted longer length of stay (+92% and +145% respectively, p 0. 05) and higher total hospital charges (+24% and +36% respectively, p 0. 05) after adjustment for demographics, comorbidities, and hospital characteristics. When adding post-COVID PF and ARDS as covariates, differences in length of stay and total charges in the COVID era decreased slightly but remained significantly different from pre-COVID numbers. Conclusion This study showed that the COVID era required increased inpatient resource utilization as reflected by longer length of stay and higher total hospital charges. Post-COVID PF and ARDS were shown to be independently associated with significantly longer hospitalizations and higher costs. Resource utilization decreased slightly when these indications were added as covariates, which suggest that both the increasing complexity of patients and increase in systemic healthcare strain accounted for the COVID-era effect. This abstract is funded by: None
Gupta et al. (Fri,) studied this question.