Outcomes of early hospital readmission after kidney transplantation: Perspectives from a Canadian transplant centre.

Olusegun Famure, Esther D Kim, Yanhong Li, Johnny W Huang, Roman Zyla, Magdalene Au, Pei Xuan Chen, Heebah Sultan, Monika Ashwin, Michelle Minkovich, S Joseph Kim
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Abstract

Background: Early hospital readmissions (EHRs) after kidney transplantation range in incidence from 18%-47% and are important and substantial healthcare quality indicators. EHR can adversely impact clinical outcomes such as graft function and patient mortality as well as healthcare costs. EHRs have been extensively studied in American healthcare systems, but these associations have not been explored within a Canadian setting. Due to significant differences in the delivery of healthcare and patient outcomes, results from American studies cannot be readily applicable to Canadian populations. A better understanding of EHR can facilitate improved discharge planning and long-term outpatient management post kidney transplant.

Aim: To explore the burden of EHR on kidney transplant recipients (KTRs) and the Canadian healthcare system in a large transplant centre.

Methods: This single centre cohort study included 1564 KTRs recruited from January 1, 2009 to December 31, 2017, with a 1-year follow-up. We defined EHR as hospitalizations within 30 d or 90 d of transplant discharge, excluding elective procedures. Multivariable Cox and linear regression models were used to examine EHR, late hospital readmissions (defined as hospitalizations within 31-365 d for 30-d EHR and within 91-365 d for 90-d EHR), and outcomes including graft function and patient mortality.

Results: In this study, 307 (22.4%) and 394 (29.6%) KTRs had 30-d and 90-d EHRs, respectively. Factors such as having previous cases of rejection, being transplanted in more recent years, having a longer duration of dialysis pretransplant, and having an expanded criteria donor were associated with EHR post-transplant. The cumulative probability of death censored graft failure, as well as total graft failure, was higher among the 90-d EHR group as compared to patients with no EHR. While multivariable models found no significant association between EHR and patient mortality, patients with EHR were at an increased risk of late hospital readmissions, poorer kidney function throughout the 1st year post-transplant, and higher hospital-based care costs within the 1st year of follow-up.

Conclusion: EHRs are associated with suboptimal outcomes after kidney transplant and increased financial burden on the healthcare system. The results warrant the need for effective strategies to reduce post-transplant EHR.

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肾移植术后早期再入院的结果:加拿大移植中心的观点。
背景:肾移植术后早期再入院(EHRs)的发生率在 18%-47% 之间,是一项重要的实质性医疗质量指标。EHR 会对移植功能和患者死亡率等临床结果以及医疗成本产生不利影响。电子病历已在美国医疗保健系统中得到广泛研究,但在加拿大环境中尚未对这些关联进行探讨。由于医疗保健的提供和患者的治疗效果存在很大差异,美国的研究结果不能轻易应用于加拿大人群。更好地了解电子病历有助于改善肾移植后的出院计划和长期门诊管理。目的:在一个大型移植中心探讨电子病历对肾移植受者(KTR)和加拿大医疗保健系统造成的负担:这项单一中心队列研究纳入了 2009 年 1 月 1 日至 2017 年 12 月 31 日期间招募的 1564 名 KTR,并进行了为期 1 年的随访。我们将 EHR 定义为移植出院后 30 天或 90 天内的住院治疗,不包括选择性手术。我们使用多变量 Cox 和线性回归模型来研究 EHR、晚期再住院(30 天 EHR 定义为 31-365 天内住院,90 天 EHR 定义为 91-365 天内住院)以及包括移植功能和患者死亡率在内的结果:在这项研究中,分别有 307 例(22.4%)和 394 例(29.6%)KTR 患者的 EHR 为 30 天和 90 天。既往有排斥反应病例、近年移植、移植前透析时间较长以及扩大标准供体等因素与移植后EHR有关。与未发生 EHR 的患者相比,90 天 EHR 组患者发生移植失败的累积死亡概率和移植失败的累积概率更高。虽然多变量模型没有发现电子病历与患者死亡率之间有明显关联,但有电子病历的患者晚期再入院的风险增加,移植后第一年肾功能较差,随访第一年的医院护理费用较高:结论:电子病历与肾移植后的不良预后和医疗系统的经济负担增加有关。结论:EHR 与肾移植后的不良预后和医疗系统的经济负担增加有关,因此有必要采取有效策略减少移植后 EHR。
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