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Journal article
Early Rehospitalization After Kidney Transplantation: Assessing Preventability and Prognosis
American journal of transplantation, v 13(12), pp 3164-3172
01 Dec 2013
PMID: 24165498
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Early rehospitalization after kidney transplantation (KT) is common and may predict future adverse outcomes. Previous studies using claims data have been limited in identifying preventable rehospitalizations. We assembled a cohort of 753 adults at our institution undergoing KT from January 1, 2003 to December 31, 2007. Two physicians independently reviewed medical records of 237 patients (32%) with early rehospitalization and identified (1) primary reason for and (2) preventability of rehospitalization. Mortality and graft failure were ascertained through linkage to the Scientific Registry of Transplant Recipients. Leading reasons for rehospitalization included surgical complications (15%), rejection (14%), volume shifts (11%) and systemic and surgical wound infections (11% and 2.5%). Reviewer agreement on primary reason (85% of cases) was strong (kappa=0.78). Only 19 rehospitalizations (8%) met preventability criteria. Using logistic regression, weekend discharge (odds ratio [OR] 1.59, p=0.01), waitlist time (OR 1.10, p=0.04) and longer initial length of stay (OR 1.42, p=0.03) were associated with early rehospitalization. Using Cox regression, early rehospitalization was associated with mortality (hazard ratio [HR] 1.55; p=0.03) but not graft loss (HR 1.33; p=0.09). Early rehospitalization has diverse causes and presents challenges as a quality metric after KT. These results should be validated prospectively at multiple centers to identify vulnerable patients and modifiable processes-of-care.
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Details
- Title
- Early Rehospitalization After Kidney Transplantation: Assessing Preventability and Prognosis
- Creators
- M. Harhay - University of PennsylvaniaE. Lin - University of PennsylvaniaA. Pai - Penn Hosp, Div Renal, Philadelphia, PA 19107 USAM. O. Harhay - University of PennsylvaniaA. Huverserian - Washington University in St. LouisA. Mussell - University of PennsylvaniaP. Abt - Department of Surgery; Transplant Institute; University of Pennsylvania; Philadelphia PAM. Levine - Department of Surgery; Transplant Institute; University of Pennsylvania; Philadelphia PAR. Bloom - University of PennsylvaniaJ. A. Shea - University of PennsylvaniaA. B. Troxel - University of PennsylvaniaP. P. Reese - University of Pennsylvania
- Publication Details
- American journal of transplantation, v 13(12), pp 3164-3172
- Publisher
- Wiley
- Number of pages
- 9
- Grant note
- 5T32DK007006-38; F32DK096758-01 / National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) T32DK007006 / NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine; SOM Dean - Research Administration
- Web of Science ID
- WOS:000327235300018
- Scopus ID
- 2-s2.0-84888322997
- Other Identifier
- 991019335487804721
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Surgery
- Transplantation