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

Abstract

Introduction: Early emergency department and hospital re-admissions are common in renal transplant recipients, but data are lacking in unique populations. Study Aim: The purpose of this study was to identify patient risk factors for multiple acute care utilization events within the first year of renal transplantation. Design: This was a single-center, retrospective cohort study of adult renal transplant recipients between 9/2013-9/2016. Patients were compared across number of emergency department visits and by hospital re-admissions. Diagnoses were categorized. Univariate and multivariate logistic regression was used to assess risk for multiple acute care utilization events within the first 12 months post-transplant. Results: A total of 216 patients were analyzed and were on average 50.5 (SD 13.9) years old, redominantly Black (49.77%) with an average body mass index of 33.33 (9.8) and were recipients of deceased donor renal transplants (61.11%). A total of 105 (48.6%) patients visited the emergency epartment and 119 (55.1%) patients had a hospital readmission. Patients having a body mass index >35 kg/m2 did not differ across emergency department visit or hospitalization groups. Delayed graft function (OR 2.86, 95% CI 1.07-7.65) and previous renal transplant (OR 2.77, 95% CI 1.04-7.39) were significantly associated with multiple acute care utilizations. Discussion: Acute care utilization following renal transplantation was similar to previously reported experiences. Obesity did not impact use of acute care resources or patient outcomes. Strategies addressing potential preventable emergency visits and hospital re-dmissions should be promoted.

Long-term Outcomes Following a Comprehensive Quality Assurance and Process Improvement Endeavor to Minimize Opioid Use After Kidney Transplant

“…By using a multimodal approach consisting of an intraoperative nerve block and scheduled acetaminophen, Dualeh et al were able to decrease the quantity of opioids prescribed at hospital discharge. Similar results were published by Lichvar et al, who found that opioid prescriptions at discharge in kidney graft recipients was significantly lower after an opioid-sparing protocol and educational session were implemented. Other transplant centers across the US have shown comparable results after implementation of similar opioid-sparing protocols in the perioperative transplant period .…”

Incidence, predictors, and outcomes of early hospital readmissions after kidney transplantation: Systemic review and meta-analysis

“…Prolonged hospital stay could lead to higher chances of contracting infections. A shorter length of stay may indicate a low-risk recipient receiving a kidney from a low-risk donor (19). EHR was also significantly associated with death-censored graft failure and mortality within the first year of kidney transplant.…”

“…Out of these, 52 full-text articles that aligned with the objective of the manuscript were reviewed. Ultimately, 17 studies were included in the final analysis, out of which twelve were cohort studies (10 retrospective, 1 prospective, and 1 ambispective) and one was a case-control study (5,(8)(9)(10)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Supplementary Figure 1 presents the PRISMA flowchart outlining the search process.…”

Utilization of the emergency department by kidney transplant recipients: a retrospective cohort study from a high-volume transplant center

“…In the literature, there are several comprehensive studies evaluating hospital re-admissions and ED visits among renal transplant recipients 5 – 7 . However, there is limited data on the usage of the ED post-renal transplantation in Saudi Arabia and the Middle East.…”