Never events and hospital-acquired conditions after kidney transplant

Abstract

Introduction: Never events (NE) and hospital-acquired conditions (HAC) after surgery have been designated as quality metrics in healthcare by the centres for Medicare and Medicaid Services (CMS). Methods: The Nationwide Inpatient Sample (NIS) database 2002-2012 was used to identify patients underwent kidney transplant. Multivariate analysis using logistic regression was used to identify outcomes and risk factors of HAC and NE after transplantation; however, we were limited by using a retrospective database missing some important variables specified for the kidney transplant, such as some operative factors, donor factors, and cold and warm ischemia times. Results: Among 35 058 patients who underwent kidney transplant, there were 11 NEs, all of which were due to retained foreign bodies. Among HAC after surgery, falling was the most common (44.9%), followed by poor glycemic control (21.7%), vascular catheter-associated infection (21%), and catheter-associated urinary tract infection (8%). HAC and NE after surgery lead to a significant increase in mortality (adjusted odds ratio [AOR] 2.49; p=0.04), hospitalization length (13 vs. 7 days; p<0.01), and total hospital charges ($231 801 vs. $146 717; p<0.01). A significantly higher risk of HAC or NE was seen for patients who had more loss of function before surgey (AOR 3.25; p<0.01) and patients expected to have higher postoperative mortality before operation (AOR 1.62; p=0.03).

Patient Co-Morbidity and Functional Status Influence the Occurrence of Hospital Acquired Conditions More Strongly than Hospital Factors

“…Several studies have reported the importance of patient factors to the development of HAC. [7][8][9][10][11][12][13] Wen et al8 studied the influence of patient factors on NE and HAC occurrence following cerebrovascular surgery; they noted that age and the presence of ≥ 2 comorbidities were strong independent predictors of HACs. They also advocated for development of risk-adjusted models.…”

“…This agrees with other reports regarding the association between NE and HAC with patient outcomes, increased hospital charges, and length of hospital stay. [7][8][9][10][11] With this administrative data, however, we cannot determine whether HACs represent a causative factor on morbidity, mortality, and hospital charges; the data can only identify a correlation. And, since HAC most strongly correlated with high patient comorbidity, present preoperatively, it is possible that patient morbidity is the primary factor driving morbidity, mortality, hospital charges, and HAC development.…”

“…This is in line with previously published articles. 11,31,32 Appropriate preventive strategies such as the removal of the catheter as soon as possible or avoidance of its use may be helpful. [32][33][34][35] Saint et al reported that 38% of physicians were not aware of the status of urinary catheter use for their patients, so reminder systems involving staff nurses and virtual reminders involving the use of electronic devices may help decrease the risk of catheter-related urinary tract infection.…”

Hospital Epidemiology and Infection Control in the Transplant Center

“…CAUTI disproportionately affect solid organ transplant (SOT) recipients, with the most data available for kidney transplant recipients. In an analysis of kidney transplant recipients in the United States from 2002 to 2012, 7.5% of kidney transplant recipients developed CAUTI [29]. Patient-specific risk factors for CAUTI in kidney transplant include age, female sex, and pre-transplant loss of function.…”

Incidencia de infecciones en el postrasplante renal inmediato

“…Por último, otro de los factores que predispone para el desarrollo de ITU en el receptor de un TR es la presencia de Diabetes Mellitus 10,11,21 . Otra de las causas de infección presente en los receptores de un TR es, según la bibliografía 22 , la infección relacionada con catéter. Esto se debe al uso de catéteres venosos centrales (CVC) como práctica habitual, ya que está especialmente indicado en aquellos pacientes que precisan de un acceso venoso por tiempo prolongado, ya sea para la administración de medicación o para la extracción de sangre.…”