Early hospital readmission after kidney transplantation under a public health care system

Abstract

Early hospital readmission (EHR) is associated with increased mortality after kidneytransplantation. This is influenced by population demographics and the comprehensiveness of the healthcare system. We investigated the incidence and risk factors associated with EHR and 1-year patient and graft survivals. Methods:We included all recipients of kidney transplant between 2011 and 2012.We excluded recipients younger than 18 years, retransplants and who died or lost the graft during the index hospital admission.Results: Among 1175 recipients, the incidence of EHR was 26.6%. The main reasons for EHR were infection (67%), surgical complications (14%), and metabolic disturbances (11%). Independent risk factors associated with EHR were recipient age (OR = 1.95, 95% CI 1.46-2.63, P < 0.001), CMV serology negative (OR = 2.2, 95% CI 1.31-3.65, P = 0.003), use of rabbit anti-thymocyte globulin (OR = 2.06, 95% CI 1.33-3.13, P < 0.001), treatment for acute rejection during index hospitalization (OR = 1.68, 95% CI 1.15-2.47, P = 0.008), and length of stay (OR = 1.72, 95% CI 1.18-2.5, P = 0.005). Patient (88.8% vs 97.6%, P < 0.001) and death-censored graft (97.4% vs 99.0%, P < 0.001) survivals were inferior comparing patients with and without EHR.Conclusion: EHR was independently associated with mortality (OR 4.01, 95% CI 2.13-7.54, P < 0.001), but its incidence and causes are directly related to the local characteristics of the population and healthcare system. K E Y W O R D S early readmission, kidney transplantation, mortality, prognosis S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Tavares MG, Cristelli MP, Ivani de Paula M, et al. Early hospital readmission after kidney transplantation under a public health care system. Clin

Factors Influencing Emergency Department Utilization and Hospital Re-Admissions in a Predominantly Obese, Racially Diverse Urban Renal Transplant Population

“…Longer transplant admission LOS was observed more frequently in patients with ED visits and hospitalizations. Longer hospital stay was associated with an increased risk of early hospital readmissions in a study by Tavares et al 18 This prolonged LOS could be observed in the setting of DGF and also in patients with numerous comorbidities, which may necessitate a longer transplant admission. These increased LOS transplant admissions are surrogate markers for overall patient vulnerabilities and reflect their overall comorbid condition burdens.…”

Quality Metrics in Solid Organ Transplantation

“…Early hospital readmission was the most frequently reported quality metric and was noted in 26 separate publications. 18,19,24,25,42,[44][45][46]49,51,[54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69] Patient survival was the next most frequently reported quality metric (n = 20 publications), 19,20,24,25,27,28,30,31,33,35,38,42,51,52,[71][72][73][74][75][76] followed by graft survival (n = 16 publications), 19,20,24,27,…”

Unplanned hospital readmissions after kidney transplantation among patients in Hefei, China: Incidence, causes and risk factors

“…Patients who experience an unplanned readmission after KT have a 50% higher mortality rate than those without an unplanned readmission [ 8 ]. Unplanned readmissions not only negatively affect a patient’s physical and mental well-being, but also increase the financial burden and limits healthcare resources [ 9 ]. Therefore, reducing the unplanned readmission rate after KT is beneficial for both the patients and institutions.…”

“…Nationally, the incidence rate of unplanned readmissions after KT within 30 days ranges from 20.6% to 45% [ [10] , [11] , [12] ], a substantially higher rate than for patients undergoing other surgeries (4%–15%) [ 13 ]. Prior studies have identified several risk factors for the 30-day readmission rate, such as recipient age, comorbid diabetes mellitus, length of stay, cytomegalovirus (CMV) serology negative, deceased kidney donation, delayed graft functioning and low glomerular filtration rate at discharge [ 9 , 14 , 15 ]. However, these studies focused on the short term [ [16] , [17] , [18] , [19] ], with a lack of long-term follow-up data.…”