Early Post-Transplant Hospital Readmission Factors Identified
Older kidney transplant (KT) recipients and those of African-American race are at significantly higher risk of early hospital readmission (EHR) after transplantation, a study found.
In addition, EHR, defined as at least one hospital readmission to an acute care hospital within 30 days after discharge from initial KT, was significantly more likely among recipients of expanded criteria donor (ECD) kidneys, obese patients, those with diabetes or other comorbidities, and those who had a longer initial hospital length of stay, according to an online report in the American Journal of Transplantation.
The new findings may have important implications for clinical practice by helping to identify which KT recipients are at increased risk for readmission, researchers led by Dorry L. Segev, MD, PhD, of the Johns Hopkins University School of Medicine in Baltimore, concluded. “Recipients at risk could be targeted for better transitions of care and coordination of care at discharge from KT.”
Dr. Segev's team examined data from 32,961 Medicare patients who underwent primary kidney transplantation from 2000 to 2005. Of these, 31% had EHR. The mean time to EHR was 10.1 days and the mean cost of readmissions was $10,551.
“We were surprised by the very high rate of early readmission,” Dr. Segev told Renal & Urology News. “Nearly one-third of transplant patients are readmitted. It is highly likely that some, if not many, of these readmissions are preventable through targeted intervention, surveillance, and novel post-discharge mechanisms.”
Each 10-year increment in age at transplantation was associated with a significant 6% increased risk of EHR for patients younger than 40 years, a 2% increased risk for those aged 40-70, and a 40% increased risk for recipients older than 70, Dr. Segev's group reported. A 60-year-old had a 17% increased risk of EHR compared with a 20-year-old after controlling for all other factors.
African-American recipients had a significant 11% increased risk compared with non-African-American patients. Compared with patients who received a kidney from a live donor, those who received an ECD kidney had a 12% increased risk of EHR.
In addition, the study found that women with diabetes had a 29% increased risk of EHR compared with women who did not. Men with diabetes had a 12% increased risk compared with men who did not.
The study also demonstrated an association between hospital length of stay after transplantation. Patients who stay was less than five days had a significant 17% decreased risk of EHR per day, whereas recipients whose stay was five days or more had a significant 7% increased risk per day.
“A short length of stay was likely associated with a low risk of readmission because short length of stay, in many cases, reflects a low-risk recipient with an organ from a low-risk donor,” Dr. Segev and his colleagues explained.