Outcomes and Health Care Utilization After Early Hospital Dismissal in Kidney Transplantation

Abstract

Objective: To understand whether reduced lengths of stay after kidney transplantation were associated with excess health care utilization in the first 90 days or long-term graft and patient survival outcomes. Background: Reducing length of stay after kidney transplant has an unknown effect on post-transplant health care utilization. We studied this association in a cohort of 1001 consecutive kidney transplants. Methods: We retrospectively reviewed 2011-2015 data from a prospectively-maintained kidney transplant database from a single center. Results: A total of 1001 patients underwent kidney transplant, and were dismissed from the hospital in 3 groups: Early [ 2 days] (19.8%), Normal [3-7 days] (79.4%) and Late [>7 days] (3.8%). 34.8% of patients had living donor transplants (Early 51%, Normal 31.4%, Late 18.4%, P < 0.001). Early patients had lower delayed graft function rates (Early 19.2%, Normal 32%, Late73.7%, P ¼ 0.001). By the hospital dismissal group, there were no differences in readmissions or emergency room visits at 30 or 90 days. Glomerular filtration rate at 12 months and rates of biopsy-proven acute rejection were also similar between groups. The timing of hospital dismissal was not associated with the risk-adjusted likelihood of readmission. Early and Normal patients had similar graft and patient survival. Late dismissal patients, who had higher rates of cardiovascular complications, had significantly higher late mortality versus Normal dismissal patients in unadjusted and riskadjusted models. Conclusion: Dismissing patients from the hospital 2 days after kidney transplant is safe, feasible, and improves value. It is not associated with excess health care utilization or worse short or long-term transplant outcomes.

Kidney donor profile index and post‐transplant health care utilization: Implications for value of transplant care delivery

“…We were able to accept these types of kidneys in this cohort and into the current era related to continuous improvement of care processes. Due to a high rate of suboptimal kidney utilization, we have developed a robust outpatient post‐transplant management program that facilitates early hospital dismissal with or without DGF 22–24 . This model includes pre‐emptively keeping patients located near the center for 4–6 weeks after transplant, aggressive use of outpatient dialysis and clinic visits, and strong relationships with referring providers.…”

Successful outcomes with transplanting kidneys from deceased donors with acute kidney injuryon temporary renal replacement therapy

“…At our center, we discharge patients on day 2 or 3, irrespective of DGF, and monitor them closely in the outpatient setting. 19 Patients with ongoing delayed function get a biopsy of the allograft at 2-4 weeks post-transplant.…”

“…Goals for trough tacrolimus levels were 8–10 ng/mL for the first month and then 6–8 ng/mL thereafter. At our center, we discharge patients on day 2 or 3, irrespective of DGF, and monitor them closely in the outpatient setting 19 . Patients with ongoing delayed function get a biopsy of the allograft at 2–4 weeks post‐transplant.…”

Postoperative length of stay following kidney transplantation in patients without delayed graft function—An analysis of center‐level variation and patient outcomes

“…[6][7][8] Notably, in a study of 364 609 patients undergoing major abdominal operations including colectomy, hepatectomy, and pancreaticoduodenectomy, Turrentine et al reported lower readmission rates among patients discharged earlier than the median discharge time for each respective surgical procedure. 9 While individual transplant programs have developed protocols to accelerate the discharge of transplant recipients, 10,11 formal examination of expedited discharge following kidney transplantation remains limited. Calderon et al 10 examined ∼1000 kidney transplant recipients at a single center and noted comparable patient and graft survival as well as 30-and 90-day readmissions among patients discharged within 2 days of transplantation.…”