Most early hospital readmissions following kidney transplantation are due to complex medical factors related to the transplantation process and not poor quality of care, according to researchers.
Meera Nair Harhay, MD, MSCE, instructor of medicine in the Renal, Electrolyte and Hypertension Division at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues assembled a cohort of 753 adults who had received a kidney transplant at a University of Pennsylvania Health System facility at some point from January 2003 through December 2007. Mortality and graft failure were ascertained through linkage to the Scientific Registry of Transplant Recipients.
Of the 753 patients, 237 (31.5%) had been hospitalized again within 30 days of discharge after transplantation (median nine days). Ninety-two percent of these readmissions were attributable to transplant-related factors. Intensive chart review revealed that the leading reasons for rehospitalization included surgical complications (15%), organ rejection (14%), volume shifts (11%), and systemic and surgical wound infections (11% and 2.5%, respectively). Two physicians reviewing the records determined that only 19 of the early rehospitalizations (8%) met preventability criteria.
Dr. Harhay’s team found that weekend discharge, longer waitlist time, and longer initial length of stay were associated with early rehospitalization and with mortality, but not with all-cause graft loss. Kidney transplant recipients with early rehospitalizations were 55% more likely to die within a six-year follow-up period than where recipients who had not been rehospitalized.
As Dr. Harhay and her colleagues pointed out in their report for American Journal of Transplantation, recent changes in Medicare reimbursement penalize facilities for early rehospitalization of patients after certain admissions, and excess rehospitalization rates are scrutinized as an indicator of quality of care. The authors wrote, however, that their “rigorous chart review process has identified the diversity of causes for these events and suggests that a minority of these events were preventable.”