Postoperative length of stay following kidney transplantation in patients without delayed graft function—An analysis of center‐level variation and patient outcomes

Abstract

Background: Early discharge after surgical procedures has been proposed as a novel strategy to reduce healthcare expenditures. However, national analyses of the association between discharge timing and post-transplant outcomes following kidney transplantation are lacking. Methods: This was a retrospective cohort study of all adult kidney transplant recipients without delayed graft function from 2014 to 2019 in the Organ Procurement and Transplantation Network and Nationwide Readmissions Databases. Recipients were divided into Early (LOS ≤ 4 days), Routine (LOS 5-7), and Delayed (LOS > 7) cohorts. Results: Of 61 798 kidney transplant recipients, 26 821 (43%) were discharged Early and 23 279 (38%) Routine. Compared to Routine, patients discharged Early were younger (52 [41-61] vs. 54 [43-62] years, p < .001), less commonly Black (33% vs. 34%, p < .001), and more frequently had private insurance (41% vs. 35%, p < .001). After adjustment, Early discharge was not associated with inferior 1-year patient survival (Hazard Ratio [HR] .74, 95% Confidence Interval [CI] 0.66-0.84) or increased likelihood of nonelective readmission at 90-days (HR .93, CI .89-.97), relative to Routine discharge. Discharging all Routine patients as Early would result in an estimated cost saving of ∼$40 million per year. Multi-level modeling of post-transplantationLOS revealed that 28.8% of the variation in LOS was attributable to interhospital differences rather than patient factors.

Trends in kidney transplantation and living donor nephrectomy in Germany: a total population analysis from 2006 to 2021

“…In general, early discharge after surgical procedures has been lately proposed to reduce healthcare expenditures. A recent study showed that early discharge after KT appears to be cost-efficient and not associated with inferior post-transplant survival or increased readmission at 90 days [ 24 ]. Our analysis showed further that LOS differed significantly for open versus laparoscopic versus robotic nephrectomy for LDN (9 ± 3.1 vs. 8 ± 2.9 vs. 6 ± 2.6; p = 0.031).…”

A Transplant-Inclusive Value-Based Kidney Care Payment Model

“…Reducing primary hospitalization length of stay after kidney transplantation to ≤4 days has recently been shown to be noninferior to a “regular” 5 to 7 day length of stay for 1 year patient survival, graft survival, and 90-day readmission rates. 43 These authors note that an early versus regular discharge policy would have realized $200 million in cost-savings over 5 years. Additional opportunities to reduce lengths of stay include expanding outpatient infusion capabilities for administering induction immunosuppression, and tailor induction agents for patient subgroups.…”