Emergency department visits and unanticipated readmissions after liver transplantation: A retrospective observational study

Oh, Seung Young; Lee, Jeong Moo; Lee, Hannah; Jung, Chul-Woo; Yi, Nam Joon; Lee, Kwang Woong; Suh, Kyung Suk; Ryu, Ho Geol

doi:10.1038/s41598-018-22404-8

Cited by 7 publications

(7 citation statements)

References 18 publications

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“…The most common presenting complaints were GI symptoms (18%), infectious disease symptoms (9%), and respiratory symptoms (8%). These results were similar to those of the two studies done in South Korea and the US [ 13 , 17 ]. Contrary to our results, two other studies had different outcomes, with one study having infectious, gastrointestinal, and musculoskeletal symptoms as the most common presenting complaints [ 16 ], and the other study having electrolyte imbalance, gastrointestinal symptoms, and infectious symptoms as the most common presenting complaints [ 16 ].…”

Section: Discussionsupporting

confidence: 92%

“…The study conducted in South Korea was more similar to this study’s methodology, with visits three years post-live transplant being assessed. Taking only the first three years into consideration, first-year ED presentations accounted for 59% of total visits in those years, which is comparable to the 64% in the Korean study [ 17 ]. Compared to previously mentioned studies, our study assessed the visits of patients after three years of discharge and found the visits to be as high as 26% of all visits assessed.…”

Section: Discussionsupporting

confidence: 52%

“…The study conducted represents one of the studies with the largest number of liver transplant patients. Compared to other studies done over the years in different countries with sample sizes of 56, 332, and 430 liver transplant patients [ 15 - 17 ], our study included 699 patients in its analysis with a total of 5225 emergency visits. This highlights the increased number of patients undergoing liver transplants and the necessity of further understanding their needs and emergencies.…”

Section: Discussionmentioning

confidence: 99%

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Emergency Department Frequentation and Unscheduled Visits of Liver Transplant Patients: Ten Years Experience in Tertiary Care Center, Saudi Arabia

Aljumaa,

AlShathri,

Aljumaa

et al. 2023

Cureus

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Introduction and objectives Liver transplantation and its indications represent an increased burden on patients' health. This can be represented in a variety of ways, such as in emergency visits, unscheduled clinic visits, and unanticipated admissions. This study aims to analyze emergency department (ED) visits, the most common presenting complaints, and the outcomes of those visits. Methods A retrospective observational study was performed in which electronic medical records were reviewed for all patients who underwent liver transplantation and presented to the emergency department between October 2011 and October 2021. The following data were collected: demographics, comorbidities, liver transplant features, and emergency department visit data and outcomes. Recurrent visits were assessed and labeled as first, second, third, fourth, and fifth or more. Results A total of 699 patients and 5,225 visits were included in the analysis. Living donors accounted for 80% of all transplants. The mean post-operative length of stay was 22.6 ± 17.8. The majority of patients (74%) had at least one comorbidity, with diabetes (47%), hypertension (31%), and chronic kidney disease (CKD) (16%) being the commonest comorbidities; however, comorbidities were not associated with an increased risk of emergency department visits. Out of the 5,225 visits to the emergency department, 2,265 (41%) were within the first year. Emergency department visits in the first seven days after discharge amounted to 22% of total first visits. By 30 days, six months, and one year, they increased to 46%, 83%, and 91%, respectively. Living donor recipients had an average of 7.3 ED visits as compared to deceased donor recipients, who had an average of 8.4 ED visits. The most common presenting complaints were gastrointestinal (GI) symptoms (18%), infectious disease symptoms (9%), and respiratory symptoms (8%). There were a total of 296 patients who were readmitted at least once since discharge after liver transplantation. Conclusion The majority of first-time presentations to ED occurred in the first year post-transplant, marking this time period as critical for liver transplant patients. Our study also highlighted the continual presentations of liver transplant patients to the ED a few years post-transplant. This requires close scrutiny of the main causes of such presentations as well as comparison with other transplant cases to identify whether they are specific to liver transplants or not.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

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Emergency Department Frequentation and Unscheduled Visits of Liver Transplant Patients: Ten Years Experience in Tertiary Care Center, Saudi Arabia

Aljumaa,

AlShathri,

Aljumaa

et al. 2023

Cureus

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“…In order to assess the impact of readmission on long-term survival we looked at patient survival at 1 and 2 years after transplantation, and found that patients with at least one readmission had lower survival than those who were not readmitted. Similar results were found by several studies, showing that readmission is associated with lower long-term patient survival (2,3,6,8,(11)(12)(13). Emergency room visits may be an indicator of higher risk after liver transplantation.…”

Section: Discussionsupporting

confidence: 88%

Emergency department frequentation and unscheduled readmissions within the first year after liver transplantation, and their impact on survival

Ávila

Cítores²,

Milla

et al. 2021

Rev Esp Enferm Dig

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The goal of this research was to assess emergency room frequentation and visit causes, and unscheduled readmissions within the first year after liver transplantation discharge from hospital, as well as their impact on graft and patient survival. This was a retrospective study of the medical records of 98 patients (mean age, 55.6 ± 8.59 years, 77.6 % males) who were consecutively discharged from hospital after receiving a first liver transplant in our institution during the period 2012-2015. All visits to the emergency room during the first year after transplantation were analyzed, and survival at two years after transplantation was calculated. Fifty-six of all 98 patients (57.15 %) visited the emergency room on 117 occasions within the first year posttransplantation. Fever (n = 34; 29.05 %) and digestive symptoms (n = 32; 27.35 %) were the most common causes of consultation, and resulted in over half of visits.Thirty-five of these 56 patients (62.5 %) required urgent readmission during 50 of all 117 (42.7 %) visits, primarily because of infectious complications (44 %) diverse causes (bacterial pneumonia, cholangitis, Clostridium difficile colitis), and biliary tract-related issues. The likelihood of readmission increased from 11.22 % at 30 days after discharge to 22.4 % at 90 days after discharge. Patient survival at 1 and 2 years after transplantation was lower for patients who were readmitted (88.4 % and 80.7 %, respectively) when compared to those who were not (95.56 % and 91.17 %, respectively, p = 0.002).

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“…In general, these patients are readmitted following presentation to either the ambulatory transplant clinic or ED. Although we do not have data on the number of patients that present to the ambulatory transplant clinic within 30 days post SOT, previous work has shown ED visits at 30 days to vary greatly between SOT groups (eg, as low as 17% for patients with kidney transplants, and as high as 44% for patients with liver transplants) [ 24 , 25 ]. Given this variability, we hypothesized a conservative estimate of 20% for our 30-day composite end point.…”

Section: Methodsmentioning

confidence: 99%

Remote Mobile Outpatient Monitoring in Transplant (Reboot) 2.0: Protocol for a Randomized Controlled Trial

Murray¹,

Foroutan²,

Amadio³

et al. 2021

JMIR Res Protoc

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Background The number of solid organ transplants in Canada has increased 33% over the past decade. Hospital readmissions are common within the first year after transplant and are linked to increased morbidity and mortality. Nearly half of these admissions to the hospital appear to be preventable. Mobile health (mHealth) technologies hold promise to reduce admission to the hospital and improve patient outcomes, as they allow real-time monitoring and timely clinical intervention. Objective This study aims to determine whether an innovative mHealth intervention can reduce hospital readmission and unscheduled visits to the emergency department or transplant clinic. Our second objective is to assess the use of clinical and continuous ambulatory physiologic data to develop machine learning algorithms to predict the risk of infection, organ rejection, and early mortality in adult heart, kidney, and liver transplant recipients. Methods Remote Mobile Outpatient Monitoring in Transplant (Reboot) 2.0 is a two-phased single-center study to be conducted at the University Health Network in Toronto, Canada. Phase one will consist of a 1-year concealed randomized controlled trial of 400 adult heart, kidney, and liver transplant recipients. Participants will be randomized to receive either personalized communication using an mHealth app in addition to standard of care phone communication (intervention group) or standard of care communication only (control group). In phase two, the prior collected data set will be used to develop machine learning algorithms to identify early markers of rejection, infection, and graft dysfunction posttransplantation. The primary outcome will be a composite of any unscheduled hospital admission, visits to the emergency department or transplant clinic, following discharge from the index admission. Secondary outcomes will include patient-reported outcomes using validated self-administered questionnaires, 1-year graft survival rate, 1-year patient survival rate, and the number of standard of care phone voice messages. Results At the time of this paper’s completion, no results are available. Conclusions Building from previous work, this project will aim to leverage an innovative mHealth app to improve outcomes and reduce hospital readmission in adult solid organ transplant recipients. Additionally, the development of machine learning algorithms to better predict adverse health outcomes will allow for personalized medicine to tailor clinician-patient interactions and mitigate the health care burden of a growing patient population. Trial Registration ClinicalTrials.gov NCT04721288; https://www.clinicaltrials.gov/ct2/show/NCT04721288 International Registered Report Identifier (IRRID) PRR1-10.2196/26816

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Emergency department visits and unanticipated readmissions after liver transplantation: A retrospective observational study

Cited by 7 publications

References 18 publications

Emergency Department Frequentation and Unscheduled Visits of Liver Transplant Patients: Ten Years Experience in Tertiary Care Center, Saudi Arabia

Emergency Department Frequentation and Unscheduled Visits of Liver Transplant Patients: Ten Years Experience in Tertiary Care Center, Saudi Arabia

Emergency department frequentation and unscheduled readmissions within the first year after liver transplantation, and their impact on survival

Remote Mobile Outpatient Monitoring in Transplant (Reboot) 2.0: Protocol for a Randomized Controlled Trial

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