Early Postoperative Emergency Department Care of Abdominal Transplant Recipients

Abstract

Background Research on post-transplant care has predominantly focused on predictors of readmission with little attention to emergency department (ED) visits. The goal of this study was to describe early postoperative ED care of transplant recipients. Methods A secondary database analysis of adult patients who underwent abdominal organ transplantation between January 1, 2008 and December 31, 2013 and sought ED care within one year post-transplantation was conducted. Survival was compared using the Kaplan-Meier method with log-rank test. Cox proportional hazards regression analysis was performed to adjust for pertinent covariates. Results A total of 1,900 abdominal organ transplants were performed during the study period. Of these, 37% (N=711) transplant recipients sought care in the ED (1,343 total visits) with 1.89 mean ED visits per recipient. Of recipients seen in the ED, 58% received a kidney transplant and 28% received a liver transplant, with 45% of recipients presenting within the first 60 postoperative days. The most common chief complaints were gastroenterological (17%) and abnormal laboratory values or vital signs (17%). In total, 74% of recipients were readmitted and 50% of admitted patients were discharged in less than 24 hours. Transplant recipients with ED visits had lower 3-year graft (81% vs. 87%; p<0.001) and patient (89% vs. 93%; p=0.002) survival. Conclusion Transplant recipients have a high frequency of ED visits in the first post-transplantation year and high rates of subsequent hospital admission. Further investigation is needed to understand what drives recipient presentation to the ED and create care models that achieve the best outcomes.

Abdominal emergencies after liver transplantation: Presentation and surgical management

“…Transplant recipient requiring ED referral has been recently investigated and seems to be common . Within the first year after transplantation, 60%, 53.2%, 44.4%, and 32.6% of pancreas transplant, multiorgan transplant, liver transplant, and kidney transplant recipients sought care in ED, respectively . Also, the majority of ED referral in transplant recipients were made by renal patients (66.2%) followed by liver (24.5%) and combined renal (9.3%) transplant recipients .…”

“…Also, the majority of ED referral in transplant recipients were made by renal patients (66.2%) followed by liver (24.5%) and combined renal (9.3%) transplant recipients . Finally, in a 5‐year report, a total of 37.4% unique recipients sought ED care …”

“…Frequently, patients refer to the hospital with long‐lasting gastrointestinal (GI) symptoms and/or abdominal pain (17%‐31.5%). Among most common complaints by recipients seeking ED care were also reported abnormal laboratory values or vital signs (7%‐17%) and infection‐related signs (15%‐16.7%) …”

Emergency Department Visits after Kidney Transplantation

“…The 48% risk of an ED visit leading to a hospital admission in this sample compares with an overall national risk of 11%, suggesting that the higher ED visit rate among post-transplant patients may be driven largely by medical need rather than overuse of the ED. Other studies have also found high risks of admission among kidney transplant recipients who seek ED care (4,5). One interpretation of these findings is that there may be a low threshold to admit transplant recipients to the hospital; these admission decisions may differ between transplant centers and community hospitals.…”

“…Over the past 15 years, ED utilization has grown from 36.5 to 42.8 visits per 100 person-years, despite a decline in the total number of ED facilities (3). However, few studies have examined ED utilization after kidney transplantation, and the published studies have been limited to transplant recipients at a single center (4,5). In 2013 in the United States, 17,600 kidney transplantations were performed, and .190,000 people were living with a functioning kidney transplant (6), highlighting the importance of understanding care utilization in this high-risk population.…”