Inpatient rehabilitation outcomes in solid organ transplantation: Results of a unique partnership between the rehabilitation hospital and the multi-organ transplant unit in an acute hospital

Abstract

Objective: To determine the outcomes in solid organ transplant recipients following inpatient rehabilitation, as a result of a unique partnership between the rehabilitation hospital and the multiorgan transplant program in an acute hospital. Design: Retrospective observational study. Setting: Community rehabilitation hospital affiliated with a university. Participants: A cohort of 173 organ transplant patients admitted consecutively over a four-year period (2004-2008) was compared to a cohort of all rehabilitation patients (n = 9762) admitted to the same inpatient rehab facility during the same period. Interventions: Inpatient rehab program to all participants. Main Outcome Measures: Length of hospital stay, Functional Independence Measure (FIM ™) change (admission-discharge), and rate of discharges to home. Results: Outcomes were measured using components of the FIM ™ instrument, admission and discharge data. Chi-square and independent two-sample t-tests were used for statistical analysis. Compared to a general rehabilitation inpatient population, transplant rehabilitation inpatients had: more immediate (<3 days) transfers to an acute hospital (5.2% vs. 1.9%, p < 0.001); a higher rate of readmission to an acute hospital after the first 3 days (19.1% vs. 1.9%, p < 0.001); a longer mean length of stay (27 ± 19 vs. 20 ± 18 days, p < 0.001); a lower total FIM ™ change (8.9 vs. 20.9, p < 0.001); a lower FIM ™ efficiency (1.1 vs. 1.4, p < 0.001); and a higher rate of discharges to home in patients not readmitted to acute care (98.5% vs. 94.5% p < 0.001). Conclusion: Outcomes of rehabilitation in solid organ transplant patients are comparable but not identical to those in other patient groups. Inpatient rehabilitation for transplant patients is therefore fully justifiable and necessary. The ten times higher rate of transplant patient readmission to acute hospital must be communicated, facilitated, accepted and managed within a partnership strategy.

Multidisciplinary Inpatient Rehabilitation Following Heart and/or Lung Transplantation—Examining Cohort Characteristics and Clinical Outcomes

“…Consistent with previous studies, medical complications during rehabilitation were common among heart and/or lung transplant recipients, affecting 33% of admissions in the present study and typically 20% to 40% of reported admissions . The majority of observed complications were respiratory in nature (including infections, pleural effusions, and acute respiratory distress), and although there appeared to be a slightly higher incidence of complications among lung compared to heart transplant recipients, this difference was not statistically significant.…”

“…Patcai et al also report seminal data but from a mixed cohort of solid organ transplant recipients receiving inpatient rehabilitation, including 56 heart/lung transplant patients. They observed functional gains postrehabilitation, but improvements were more modest, required longer lengths of stay, and were associated with higher complication rates among transplant patients compared to general rehabilitation patients . Later work by Gupta et al in a small cohort of exclusively heart transplant recipients supported earlier findings that inpatient rehabilitation can lead to functional benefits after transplantation …”

A Review of Lung Transplantation and Its Implications for the Acute Inpatient Rehabilitation Team

“…Outcome data are limited with respect to LTs as a population; nevertheless, the increasing frequency of LT and the changing demographics of acute rehabilitation necessitate a comparison with other rehabilitation populations. Progress of LT Functional Independence Measure score gains has been found to be slower than other populations and is more in line with Functional Independence Measure gains seen in stroke patients [36,37]. Although exercise capacity and skeletal muscle function are expected to improve with exercise, therapy after transplantation studies indicate LT recipients do not reach predicted levels in maximal exercise capacity or skeletal muscle strength [35].…”

“…Hospital readmission rates in patients undergoing LT have been documented as high as 19%‐40% of total acute rehabilitation admissions [24,36,37]. Such findings warrant special considerations and close surveillance for LT patients, because they tend to have high complications rates [42‐45], slower functional gains, and more readmissions compared with other acute rehabilitation populations [24,36,37].…”

Inpatient Rehabilitation after Liver Transplantation Decreases Risk and Severity of 30-Day Readmissions

“…This likely occurs through around-the-clock interaction with health professionals, close monitoring of medications, easy access to diagnostics, and therapies to combat deconditioning. (27)…”