Does Weekend Discharge Affect Readmission and Survival in Liver Transplant Patients? Insights From a Cohort Study

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2025-01-10 DOI:10.1111/ctr.70081

Ayato Obana, Miho Akabane, Hannah Chi, Nolan Ladd, Matthew Yoder, Lily Kaufman, Rithin Punjala, Kejal Shah, Matthew Hamilton, Ashley Limkemann, Austin Schenk, Navdeep Singh, Black Slyvester, Khalid Mumtaz, Kenneth Washburn, Musab Alebrahim

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Abstract

Background

Weekend hospital discharges are often associated with reduced staffing, potentially impacting the quality of patient care. We studied the effects of weekend discharge after liver transplantation (LT) on early readmission rates, overall survival (OS), and graft survival (GS).

Method

We analyzed data from the Ohio State University Wexner Medical Center database (January 2016 to December 2023). The study included initial LT recipients (LTRs) including donation after brain death (DBD) and donation after cardiac death (DCD). Primary outcomes encompassed early readmission rates, and secondary outcomes included OS and GS.

Results

The cohort comprised 915 LTRs (645 DBD, 270 DCD), with 156 (17.0%) weekend and 759 (83.0%) weekday discharges. Regarding discharge disposition, 681 (74.4%) patients were discharged home, 210 (22.9%) were discharged to healthcare facilities. No significant differences were identified in the length of hospital stay (8 days vs. 9 days, weekend vs. weekday, respectively, p = 0.22) or 30-day readmission (29.5% vs. 32.5%, weekend vs. weekday, respectively, p = 0.75). There were no significant differences in OS (90.9% vs. 92.7% at 1-year, 84.4% vs. 88.0% at 3-year, weekend vs. weekday, p = 0.27) and GS (90.9% vs. 91.5% at 1-year, 84.0% vs. 86.6% at 3-year, weekend vs. weekday, p = 0.50). Multivariate logistic analysis showed no significant impact of weekend discharge (OR: 0.84 [0.57–1.22], p = 0.35) or discharge disposition (OR: 1.00 [0.75–1.33], p = 1.00) on 30-day readmission. Multivariate Cox regression analysis found no significant impact of weekend discharge or discharge disposition on OS and GS (all p > 0.05).

Conclusion

Weekend discharge does not impact early readmission, OS, or GS in LTRs. These findings are a testament to our multidisciplinary team efforts and suggest that with appropriate discharge planning and follow-up care, the timing of discharge may be less critical than previously assumed.

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周末出院会影响肝移植患者的再入院和生存吗？来自队列研究的见解。

背景：周末出院通常与人员减少有关，这可能会影响患者护理的质量。我们研究了肝移植术后周末出院对早期再入院率、总生存期（OS）和移植物生存期（GS）的影响。方法：分析俄亥俄州立大学Wexner医学中心数据库（2016年1月至2023年12月）的数据。该研究纳入了初始肝移植受体（LTRs），包括脑死亡后捐赠（DBD）和心脏死亡后捐赠（DCD）。主要结局包括早期再入院率，次要结局包括OS和GS。结果：该队列包括915例ltr(645例DBD， 270例DCD)，其中156例（17.0%）周末出院，759例（83.0%）工作日出院。出院处置方面，681例（74.4%）患者出院回家，210例（22.9%）患者出院到医疗机构。住院时间（8天vs. 9天，周末vs.工作日，分别p = 0.22）或30天再入院（29.5% vs. 32.5%，周末vs.工作日，分别p = 0.75）无显著差异。OS（1年90.9% vs. 92.7%， 3年84.4% vs. 88.0%，周末vs.工作日，p = 0.27）和GS（1年90.9% vs. 91.5%， 3年84.0% vs. 86.6%，周末vs.工作日，p = 0.50）无显著差异。多因素logistic分析显示，周末出院（OR: 0.84 [0.57-1.22], p = 0.35）或出院处理（OR: 1.00 [0.75-1.33], p = 1.00）对30天再入院无显著影响。多因素Cox回归分析发现，周末放血和放血处置对OS和GS无显著影响（p < 0.05）。结论：周末出院对ltr患者早期再入院、OS或GS无影响。这些发现证明了我们多学科团队的努力，并建议通过适当的出院计划和随访护理，出院时间可能不像以前假设的那么重要。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.