Pediatric Critical Care Medicine Fellow University of Michigan Ann Arbor, Michigan, United States
Background: Over 500 pediatric patients receive liver transplantation annually in the United States. Roughly two-thirds of patients remain intubated and mechanically ventilated post-operatively and likely require sedation medications. Currently, there is no standard practice or accepted care bundles for pediatric patients during their post-operative care in the ICU following liver transplantation. As such, there is significant center-level practice variation in care, including in the receipt of mechanical ventilation and sedation medications. Understanding perioperative clinical practice variation in this population was highlighted as an area for improvement by a consensus of liver transplant experts in 2019 to improve patient outcomes. To our knowledge, there are no studies exploring current practices or practice variation in sedation medication use in this population. Objective: Our study aims to utilize the Pediatric Health Information System (PHIS) database to describe temporal trends in general sedation practices and outcomes for pediatric liver transplant patients in the post-operative period and compare hospital-level practice variation. Design/Methods: This project is a secondary data analysis of the PHIS database to describe usage of different sedation medications and compare hospital-level practice variation from 2015-2022. PHIS is a large administrative database through the Children’s Hospital Association (CHA) that collects claims data, including diagnosis and procedural ICD-10 codes, and encounter-level hospital charge data, including medication administration. Inclusion criteria will be pediatric patients, 0-17 years old, who received a liver transplantation in the United States from 2015-2022. The primary outcome will be days of mechanical ventilation. Secondary outcomes include duration of sedation infusions, ICU and hospital lengths of stay, 28-day mortality, and rates of adverse events. This study has been approved by CHA and was deemed not human subjects research and exempt from review by our IRB. Statistical analysis will be completed by March 2024.
