Dataset Information

"Early" and "Late" Hospital readmissions in the first year after kidney transplant at a single center.

ABSTRACT:

Background

Hospital readmission (HR) after surgery is considered a quality metric.

Methods

Data on 2371 first-time adult kidney transplant (KT) recipients were collected to analyze the "early" (≤30 days) and "late" (31-365 days) HR patterns after KT at a single center over a 12-year time span (2002-2013).

Results

30-day, 90-day, and 1-year HR were 31%, 41%, and 53%, respectively. Risk factors for HR included age >50, female sex, black race, BMI >30, transplant LOS >5 days, and pre-transplant time on dialysis >765 days. Indications for early (n = 749) and late (n = 508) HR were similar. Early HR (OR: 3.80, P = .007) and black race (OR: 2.38, P = .009) were associated with higher odds of 1-year graft failure while frequency (1-2, 3-4, 5+) of HR (ORs: 4.68, 8.36, 9.44, P < .001) and age > 50 (OR: 2.11, P = .007) were associated with higher odds of 1-year mortality. Transplant LOS > 5 days increased both odds of 1-year graft failure (OR: 3.51, P = .001) and mortality (OR: 2.05, P = .006). One-year graft and recipient survival were 96.7% and 94.8%, respectively.

Conclusions

Hospital readmission was associated with reduced graft and patient survival; however, despite a relatively high and consistent HR rate after KT, overall 1-year graft and patient survival was high.

SUBMITTER: Nguyen MC

PROVIDER: S-EPMC9270717 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Publications

"Early" and "Late" Hospital readmissions in the first year after kidney transplant at a single center.

Nguyen Michelle C MC Nguyen Michelle C MC Avila Christina L CL Brock Guy N GN Benedict Jason A JA James Iyore I El-Hinnawi Ashraf A Rajab Amer A Elkhammas Elmahdi E Pelletier Ronald P RP Henry Mitchell M Bumgardner Ginny L GL

Clinical transplantation 20200302 3

<h4>Background</h4>Hospital readmission (HR) after surgery is considered a quality metric.<h4>Methods</h4>Data on 2371 first-time adult kidney transplant (KT) recipients were collected to analyze the "early" (≤30 days) and "late" (31-365 days) HR patterns after KT at a single center over a 12-year time span (2002-2013).<h4>Results</h4>30-day, 90-day, and 1-year HR were 31%, 41%, and 53%, respectively. Risk factors for HR included age >50, female sex, black race, BMI >30, transplant LOS >5 days, ...[more]

PMID: 32037573

Similar Datasets

Project description:RATIONALE & OBJECTIVE:A robust relationship between procedure volume and clinical outcomes has been demonstrated across many surgical fields. This study assessed whether a center volume-outcome relationship exists for contemporary kidney transplantation, specifically for diabetic recipients, older recipients (aged ?65 years), and recipients of high kidney donor profile index (KDPI ? 85) kidneys. STUDY DESIGN:Retrospective cohort study. SETTING & PARTICIPANTS:Adult kidney-only transplant recipients who underwent transplantation between 2009 and 2013 (N = 79,581). EXPOSURES:The primary exposure variable was center volume, categorized into quartiles based on the total kidney transplantation volume. Quartile 1 (Q1) centers performed a mean of fewer than 66 kidney transplantations per year, whereas Q4 centers performed a mean of more than 196 kidney transplantations per year. OUTCOMES:All-cause graft failure and mortality within 3 years of transplantation. ANALYTICAL APPROACH:Multivariable Cox frailty models were used to adjust for donor characteristics, recipient characteristics, and cold ischemia time. RESULTS:Minor differences in rates of 3-year deceased donor all-cause graft failure across quartiles of center volume were observed (14.9% for Q1 vs 16.7% for Q4), including in subgroups (diabetic recipients, 18.4% for Q1 vs 19.7% for Q4; older recipients, 19.4% for Q1 vs 22.5% for Q4; recipients of high KDPI kidneys, 26.5% for Q1 vs 26.5% for Q4). Results were similar for 3-year mortality. After adjustment for donor, recipient, and graft characteristics using Cox regression, center volume was not significantly associated with all-cause graft failure or mortality within 3 years, except that diabetic recipients at Q3 centers had slightly lower mortality (compared with Q1 centers, adjusted HR of 0.85 [95% CI, 0.73-0.99]). LIMITATIONS:Potential unmeasured confounding from patient comorbid conditions and organ selection. CONCLUSIONS:These findings provide little evidence that care in higher volume centers is associated with better adjusted outcomes for kidney transplant recipients, even in populations anticipated to be at increased risk for graft failure or death.

Project description:BackgroundEarly hospital readmissions (EHRs) occur commonly in kidney transplant recipients. Conflicting evidence exists regarding risk factors and outcomes of EHRs.ObjectiveTo determine risk factors and outcomes associated with EHRs (ie, hospitalization within 30 days of discharge from transplant hospitalization) in kidney transplant recipients.DesignPopulation-based cohort study using linked, administrative health care databases.SettingOntario, Canada.PatientsWe included 5437 kidney transplant recipients from 2002 to 2015.MeasurementsRisk factors and outcomes associated with EHRs. We assessed donor, recipient, and transplant risk factors. We also assessed the following outcomes: total graft failure, death-censored graft failure, death with a functioning graft, mortality, and late hospital readmission.MethodsWe used multivariable logistic regression to examine the association of each risk factor and the odds of EHR. To examine the relationship between EHR status (yes vs no [reference]) and the outcomes associated with EHR (eg, total graft failure), we used a multivariable Cox proportional hazards model.ResultsIn all, 1128 kidney transplant recipients (20.7%) experienced an EHR. We found the following risk factors were associated with an increased risk of EHR: older recipient age, lower income quintile, several comorbidities, longer hospitalization for initial kidney transplant, and older donor age. After adjusting for clinical characteristics, compared to recipients without an EHR, recipients with an EHR had an increased risk of total graft failure (adjusted hazard ratio [aHR]: 1.46, 95% CI: 1.29, 1.65), death-censored graft failure (aHR: 1.62, 95% CI: 1.36, 1.94), death with graft function (aHR: 1.34, 95% CI: 1.13, 1.59), mortality (aHR: 1.41, 95% CI: 1.22, 1.63), and late hospital readmission in the first 0.5 years of follow-up (eg, 0 to <0.25 years: aHR: 2.11, 95% CI: 1.85, 2.40).LimitationsWe were not able to identify which readmissions could have been preventable and there is a potential for residual confounding.ConclusionsResults can be used to identify kidney transplant recipients at risk of EHR and emphasize the need for interventions to reduce the risk of EHRs.Trial registrationThis is not applicable as this is a population-based cohort study and not a clinical trial.

Dataset Information

"Early" and "Late" Hospital readmissions in the first year after kidney transplant at a single center.

Background

Methods

Results

Conclusions

Publications

"Early" and "Late" Hospital readmissions in the first year after kidney transplant at a single center.

Similar Datasets

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