BACKGROUND: Early rehospitalization after kidney transplantation (KTx) is common and is considered a quality metric. Recipient and donor risk factors for early readmission after KTx are well studied. Little data exist on discharge-level factors associated with readmission. METHODS: We performed a single-center, retrospective cohort study between 2011 and 2015 of adult KTx recipients to examine readmission indication, risk factors, and opportunities for reduction. RESULTS: Of 462 KTxs, 145 (31.4%) were readmitted within 30 days of discharge. The primary reason for readmission was surgery-site specific in 30 cases (20.7%). Of 115 recipients with nonsurgical indications for readmission 25 (21.7%) were related to infection, 24 (20.9%) graft dysfunction, 25 (21.7%) gastrointestinal, 25 (21.7%) metabolic, and 16 (13.9%) other reasons. On multivariate analysis significant independent predictors of early readmission were electrolyte abnormalities on the day of discharge (odds ratio [OR], 1.77; 95% confidence interval [95% CI], 1.17-2.69), 3 or more comorbidities (OR, 2.01; 95% CI, 1.04-3.86), delayed graft function at the time of discharge (OR, 1.65; 95% CI, 1.00-2.70), and post-KTx hospitalization complication (OR, 1.70; 95% CI, 1.10-2.61). Among 11.7% of patients, readmission may have been attenuated by addressing the medical issue before discharge from index hospitalization. In 28.3% of patients, readmission rates may have been reduced with continued management as an outpatient or provision of observational or same-day diagnostic resources. CONCLUSIONS: Specific discharge level factors correlate with readmission irrespective of comorbidities and transplant complications. These findings may have important implications on discharge practice by aiding to identify which KTx recipients could be targeted for enhanced care transitions. Overall, potential opportunities for readmission reduction exist on multiple process levels.
BACKGROUND: Early rehospitalization after kidney transplantation (KTx) is common and is considered a quality metric. Recipient and donor risk factors for early readmission after KTx are well studied. Little data exist on discharge-level factors associated with readmission. METHODS: We performed a single-center, retrospective cohort study between 2011 and 2015 of adult KTx recipients to examine readmission indication, risk factors, and opportunities for reduction. RESULTS: Of 462 KTxs, 145 (31.4%) were readmitted within 30 days of discharge. The primary reason for readmission was surgery-site specific in 30 cases (20.7%). Of 115 recipients with nonsurgical indications for readmission 25 (21.7%) were related to infection, 24 (20.9%) graft dysfunction, 25 (21.7%) gastrointestinal, 25 (21.7%) metabolic, and 16 (13.9%) other reasons. On multivariate analysis significant independent predictors of early readmission were electrolyte abnormalities on the day of discharge (odds ratio [OR], 1.77; 95% confidence interval [95% CI], 1.17-2.69), 3 or more comorbidities (OR, 2.01; 95% CI, 1.04-3.86), delayed graft function at the time of discharge (OR, 1.65; 95% CI, 1.00-2.70), and post-KTx hospitalization complication (OR, 1.70; 95% CI, 1.10-2.61). Among 11.7% of patients, readmission may have been attenuated by addressing the medical issue before discharge from index hospitalization. In 28.3% of patients, readmission rates may have been reduced with continued management as an outpatient or provision of observational or same-day diagnostic resources. CONCLUSIONS: Specific discharge level factors correlate with readmission irrespective of comorbidities and transplant complications. These findings may have important implications on discharge practice by aiding to identify which KTx recipients could be targeted for enhanced care transitions. Overall, potential opportunities for readmission reduction exist on multiple process levels.
Authors: Mara A McAdams-DeMarco; Israel O Olorundare; Hao Ying; Fatima Warsame; Christine E Haugen; Rasheeda Hall; Jacqueline M Garonzik-Wang; Niraj M Desai; Jeremy D Walston; Silas P Norman; Dorry L Segev Journal: Transplantation Date: 2018-02 Impact factor: 4.939
Authors: Christine E Haugen; Elizabeth A King; Sunjae Bae; Mary Grace Bowring; Courtenay M Holscher; Jacqueline Garonzik-Wang; Mara McAdams-DeMarco; Dorry L Segev Journal: Am J Nephrol Date: 2018-09-18 Impact factor: 3.754
Authors: Michelle C Nguyen; Christina L Avila; Guy N Brock; Jason A Benedict; Iyore James; Ashraf El-Hinnawi; Amer Rajab; Elmahdi Elkhammas; Ronald P Pelletier; Mitchell Henry; Ginny L Bumgardner Journal: Clin Transplant Date: 2020-03-02 Impact factor: 3.456
Authors: Julien Hogan; Michael D Arenson; Sandesh M Adhikary; Kevin Li; Xingyu Zhang; Rebecca Zhang; Jeffrey N Valdez; Raymond J Lynch; Jimeng Sun; Andrew B Adams; Rachel E Patzer Journal: Transplant Direct Date: 2019-07-29
Authors: Yiman Wang; Martin B A Heemskerk; Wieneke M Michels; Aiko P J de Vries; Friedo W Dekker; Yvette Meuleman Journal: BMC Nephrol Date: 2021-04-27 Impact factor: 2.388