Entela Lushaj1, Walker Julliard1, Shahab Akhter1, Glen Leverson1, James Maloney1, Richard D Cornwell2, Keith C Meyer2, Nilto DeOliveira3. 1. Department of Surgery, Section of Cardiothoracic Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin. 2. Department of Medicine, Section of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin. 3. Department of Surgery, Section of Cardiothoracic Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin. Electronic address: oliveira@surgery.wisc.edu.
Abstract
BACKGROUND: Adverse events that require hospital readmission frequently occur long after lung transplantation (LT) that has been successfully performed. We sought to identify the causes and rate of unplanned readmissions after LT and to determine whether unplanned readmissions have a significant impact on post-LT survival. METHODS: We retrospectively reviewed the outcomes in 174 LT recipients who underwent LT at our center from June 2005 to May 2014. The median follow-up period was 38 months (range, 17 to 72 months). RESULTS: One hundred sixty (92%) of the 174 recipients were readmitted 854 times (5.3 times per patient). The median time to first readmission was 71 days (interquartile range [IQR], 28 to 240 days), and the median hospital length of stay at readmission was 3 days (IQR, 2 to 6 days). Freedom from first readmission was observed for 65% of patients at 1 month, 48% at 3 months, 43% at 6 months, and 26% at 12 months. Gender, lung allocation score, body surface area, year of transplantation, air leak longer than 5 days after operation, and allograft function were risk factors for readmission. The causes of readmission included infections (33%), respiratory adverse events (18%), rejection (15%), gastrointestinal events (15%), renal dysfunction (5%), and cardiac events (4%). Patients who died were found to have had early readmissions (p = 0.04) and more frequent readmissions (p = 0.001). CONCLUSIONS: The first year after LT remains a high-risk period for unplanned readmissions regardless of pretransplantation diagnosis. Readmissions soon after discharge at index hospitalization and multiple readmissions are associated with an increased risk of mortality.
BACKGROUND: Adverse events that require hospital readmission frequently occur long after lung transplantation (LT) that has been successfully performed. We sought to identify the causes and rate of unplanned readmissions after LT and to determine whether unplanned readmissions have a significant impact on post-LT survival. METHODS: We retrospectively reviewed the outcomes in 174 LT recipients who underwent LT at our center from June 2005 to May 2014. The median follow-up period was 38 months (range, 17 to 72 months). RESULTS: One hundred sixty (92%) of the 174 recipients were readmitted 854 times (5.3 times per patient). The median time to first readmission was 71 days (interquartile range [IQR], 28 to 240 days), and the median hospital length of stay at readmission was 3 days (IQR, 2 to 6 days). Freedom from first readmission was observed for 65% of patients at 1 month, 48% at 3 months, 43% at 6 months, and 26% at 12 months. Gender, lung allocation score, body surface area, year of transplantation, air leak longer than 5 days after operation, and allograft function were risk factors for readmission. The causes of readmission included infections (33%), respiratory adverse events (18%), rejection (15%), gastrointestinal events (15%), renal dysfunction (5%), and cardiac events (4%). Patients who died were found to have had early readmissions (p = 0.04) and more frequent readmissions (p = 0.001). CONCLUSIONS: The first year after LT remains a high-risk period for unplanned readmissions regardless of pretransplantation diagnosis. Readmissions soon after discharge at index hospitalization and multiple readmissions are associated with an increased risk of mortality.
Authors: Erik H Hoyer; William V Padula; Daniel J Brotman; Natalie Reid; Curtis Leung; Diane Lepley; Amy Deutschendorf Journal: J Gen Intern Med Date: 2017-10-02 Impact factor: 5.128
Authors: Andrew M Courtwright; Derek Zaleski; Lisa Gardo; Vivek N Ahya; Jason D Christie; Maria Crespo; Denis Hadjiliadis; James Lee; Maria Molina; Namrata Patel; Mary Porteous; Edward E Cantu; Christian Bermudez; Joshua M Diamond Journal: Transplantation Date: 2018-05 Impact factor: 4.939
Authors: James A Blumenthal; Patrick J Smith; Andrew Sherwood; Stephanie Mabe; Laurie Snyder; Courtney Frankel; Daphne C McKee; Natalie Hamilton; Francis J Keefe; Sheila Shearer; Jeanne Schwartz; Scott Palmer Journal: Transplant Direct Date: 2020-02-18