Comprehensive Analysis of a Single-Center Inpatient Post-Transplant Physical Therapy Program in High Acuity Patients: Is It Worth the Effort?

Background: High acuity post Liver Transplant (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 - July 2021). Comparative and multivariable regression analysis using 131 variables assessed patients who received group physical therapy (PT) at a dedicated area at our hospital (GYM) and patients receiving standard PT (NON-GYM). Subset analysis of GYM and NON-GYM patients assessed outcomes for high acuity patients (MELD of ≥ 35, ICU admission pre-LT, and hospitalization of ≥ 60 d).

Results: 1183 consecutive adult LTs were performed during the study period. 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 (OR 6.543, 95% CI 2.292-18.681, 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).

Conclusion: This analysis suggests 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.