Decreasing hospital length of stay with pre-transplant hepatic transarterial chemoembolization: Does it work? Analysis of unexpected admissions and hospital days

Purpose To compare the unexpected admissions and hospital days of pre-transplant hepatic transarterial chemoembolization (TACE) as managed by 23 hour observation and same day discharge. Materials and Methods This is a retrospective review of 56 pre-transplant hepatic TACE procedures at a single hepatic transplant center from September 2011 through September 2012. 20 TACE procedures were managed with intent of 23 hour observation and 36 TACE procedures were managed with intent of same day discharge. Variation between the two discharge groups was assessed by the student’s T test for age, tumor size, bilirubin, INR, Child-Pugh score, and MELD score. Unexpected admissions and hospital days were evaluated for each group. Results 56 pretransplant TACE procedures (51 conventional TACE, 5 drug eluting bead TACE) were performed on 47 patients (mean 62 yrs). Of the 23 hr observation group (mean Child-Pugh score 6.7, range 5-9), there were 4 unexpected admissions who were hospitalized for a total of 11 (range 2-4) days. Unexpected admission diagnoses for the 23 hr observation group included pain, fever, encephalopathy and hypotension. 80% (16/20) of the 23 hr discharge group did not experience unexpected admissions or hospital days. The same day discharge group (mean Child-Pugh score 6.9, range 5-12) had 3 unexpected admissions who were hospitalized for a total of 10 (range 1-6) days. Admission diagnoses for the same day discharge group included pain, nausea/vomiting and spontaneous bacterial peritonitis. 92% (33/36) of the same day discharge group were discharged on the day of the procedure without unexpected admissions or hospital days. The student’s T-test demonstrated no statistical difference between the two discharge groups when comparing age (p=0.19), tumor size (p=0.40), bilirubin (p=0.48), INR (p=0.47), Child-Pugh score (p=0.31) or MELD score (p=0.32). There was no significant difference in unexpected admissions (p=0.88) and hospital days (p=0.61) between the two TACE discharge groups. Conclusion Same-day discharge following hepatic transarterial chemoembolization can be performed in the pre-transplant population with similar rates of unexpected admission and hospital days as 23 hour observation.