Meera Nair Harhay1, Yaqi Jia2, Heather Thiessen-Philbrook2, Behdad Besharatian3, Ramnika Gumber3, Francis L Weng4, Isaac E Hall5, Mona Doshi6, Bernd Schroppel7, Chirag R Parikh2, Peter P Reese3,8. 1. Division of Nephrology & Hypertension, Drexel University College of Medicine, Philadelphia, PA, USA. 2. Yale University, New Haven, CT, USA. 3. Division of Nephrology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. 4. Robert Wood Johnson Barnabas Health, Livingston, NJ, USA. 5. University of Utah, Salt Lake City, UT, USA. 6. Wayne State University, Detroit, MI, USA. 7. Mt. Sinai Health System, New York, NY, USA. 8. Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Abstract
BACKGROUND: Kidney transplant (KT) recipients experience high rates of early (≤30 days) hospital readmission (EHR) after KT, and existing studies provide limited data on modifiable discharge factors that may mitigate EHR risk. METHODS: We performed a retrospective cohort study of 468 adult deceased donor KT recipients transplanted between 4/2010 and 11/2013 at 5 United States transplant centers. We fit multivariable mixed effects models to assess the association of two potentially modifiable discharge factors with the probability of EHR after KT: (i) weekend discharge and (ii) days to first scheduled follow-up. RESULTS: Among 468 KT recipients, 38% (n = 178) experienced EHR after KT. In fully adjusted analyses, compared to weekday discharges, KT recipients discharged on the weekend had a 29% lower risk of EHR (adjusted odds ratio [aOR] 0.71, 95% confidence interval [CI] 0.41-0.94). Compared to follow-up within 2 days of discharge, KT recipients with follow-up within 3 to 6 days had a 28% higher probability of EHR (aOR 1.28, 95% CI 1.13-1.45). CONCLUSIONS: These findings suggest that clinical decisions related to the timing of discharge and follow-up modify EHR risk after KT, independent of traditional risk factors.
BACKGROUND: Kidney transplant (KT) recipients experience high rates of early (≤30 days) hospital readmission (EHR) after KT, and existing studies provide limited data on modifiable discharge factors that may mitigate EHR risk. METHODS: We performed a retrospective cohort study of 468 adult deceased donor KT recipients transplanted between 4/2010 and 11/2013 at 5 United States transplant centers. We fit multivariable mixed effects models to assess the association of two potentially modifiable discharge factors with the probability of EHR after KT: (i) weekend discharge and (ii) days to first scheduled follow-up. RESULTS: Among 468 KT recipients, 38% (n = 178) experienced EHR after KT. In fully adjusted analyses, compared to weekday discharges, KT recipients discharged on the weekend had a 29% lower risk of EHR (adjusted odds ratio [aOR] 0.71, 95% confidence interval [CI] 0.41-0.94). Compared to follow-up within 2 days of discharge, KT recipients with follow-up within 3 to 6 days had a 28% higher probability of EHR (aOR 1.28, 95% CI 1.13-1.45). CONCLUSIONS: These findings suggest that clinical decisions related to the timing of discharge and follow-up modify EHR risk after KT, independent of traditional risk factors.
Authors: Sri G Yarlagadda; Steven G Coca; Amit X Garg; Mona Doshi; Emilio Poggio; Richard J Marcus; Chirag R Parikh Journal: Nephrol Dial Transplant Date: 2008-04-11 Impact factor: 5.992
Authors: Jennifer E Flythe; Suzanne L Katsanos; Yichun Hu; Abhijit V Kshirsagar; Ronald J Falk; Carlton R Moore Journal: Clin J Am Soc Nephrol Date: 2016-05-05 Impact factor: 8.237
Authors: Norbert I Goldfield; Elizabeth C McCullough; John S Hughes; Ana M Tang; Beth Eastman; Lisa K Rawlins; Richard F Averill Journal: Health Care Financ Rev Date: 2008
Authors: Meera Nair Harhay; Karthik Ranganna; Suzanne M Boyle; Antonia M Brown; Thalia Bajakian; Lissa B Levin Mizrahi; Gary Xiao; Stephen Guy; Gregory Malat; Dorry L Segev; David Reich; Mara McAdams-DeMarco Journal: Am J Kidney Dis Date: 2019-05-21 Impact factor: 8.860
Authors: Kyla L Naylor; Gregory A Knoll; Justin Slater; Eric McArthur; Amit X Garg; Ngan N Lam; Britney Le; Alvin H Li; Megan K McCallum; Marlee Vinegar; S Joseph Kim Journal: Can J Kidney Health Dis Date: 2021-11-29
Authors: Isaac E Hall; Peter Philip Reese; Sherry G Mansour; Sumit Mohan; Yaqi Jia; Heather R Thiessen-Philbrook; Daniel C Brennan; Mona D Doshi; Thangamani Muthukumar; Enver Akalin; Meera Nair Harhay; Bernd Schröppel; Pooja Singh; Francis L Weng; Jonathan S Bromberg; Chirag R Parikh Journal: Clin J Am Soc Nephrol Date: 2021-03-10 Impact factor: 8.237
Authors: Daan M Voeten; Leonie R van der Werf; Johanna W van Sandick; Richard van Hillegersberg; Mark I van Berge Henegouwen Journal: Surg Endosc Date: 2020-10-26 Impact factor: 4.584