The association of discharge decisions after deceased donor kidney transplantation with the risk of early readmission: Results from the deceased donor study

Harhay, Meera N.; Jia, Yaqi; Thiessen-Philbrook, Heather; Besharatian, Behdad; Gumber, Ramnika; Weng, Francis L.; Hall, Isaac E.; Doshi, Mona D.; Schröppel, Bernd; Parikh, Chirag R.; Reese, Peter P.

doi:10.1111/ctr.13215

Cited by 10 publications

(8 citation statements)

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“…Several studies investigated the effect of weekend discharge on readmission after other types of surgery than esophagectomy. None found higher readmission rates after weekend discharge [41][42][43][44][45]. All of these studies included patients both with and without complications.…”

Section: Discussionmentioning

confidence: 99%

Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

et al. 2020

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Background Within the scope of value-based health care, this study aimed to analyze Dutch hospital performance in terms of length of hospital stay after esophageal cancer surgery and its association with 30-day readmission rates. Since both parameters are influenced by the occurrence of complications, this study only included patients with an uneventful recovery after esophagectomy. Methods All patients registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) who underwent a potentially curative esophagectomy between 2015 and 2018 were considered for inclusion. Patients were excluded in case of an intraoperative/post-operative complication, readmission to the intensive care unit, or any re-intervention. Length of hospital stay was dichotomized around the national median into ‘short admissions’ and ‘long admissions’. Hospital variation was evaluated using a case-mix-corrected funnel plot based on multivariable logistic regression analyses. Association of length of hospital stay with 30-day readmission rates was investigated using the χ2-statistic. Results A total of 1007 patients was included. National median length of hospital stay was 9 days, ranging from 6.5 to 12.5 days among 17 hospitals. The percentage of ‘short admissions’ per hospital ranged from 7.7 to 93.5%. After correction for case-mix variables, 3 hospitals had significantly higher ‘short admission’ rates and 4 hospitals had significantly lower ‘short admission’ rates. Overall, 6.2% [hospital variation (0.0–13.2%)] of patients were readmitted. Hospital 30-day readmission rates were not significantly different between patients with a short length of hospital stay and those with a long length of hospital stay (5.5% versus 7.6%; p = 0.19). Conclusions Based on these nationwide audit data, median length of hospital stay after an uncomplicated esophagectomy was 9 days ranging from 6.5 to 12.5 days among Dutch hospitals. There was no association between length of hospital stay and readmission rates. Nationwide improvement might lead to a substantial reduction of hospital costs.

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Section: Discussionmentioning

confidence: 99%

Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

et al. 2020

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“…Previous studies on hospital care after kidney transplantation have focused on the issue of readmissions, specifically aimed at identifying key clinical factors predictive of readmissions. 17,18 Kidney transplantation has expanded worldwide over the last several years, 19,20 particularly related to growth in deceased donor organ donation 21 growing comfort with the use of living donors 22,23 expanding utilization of suboptimal deceased donor kidneys, 24,25 and the growing wait-list. Therefore, it is imperative to evaluate whether patient safety can be affected when innovations in postoperative care are implemented, such as reducing LOS.…”

Section: Discussionmentioning

confidence: 99%

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

Calderon

Chang

et al. 2020

Annals of Surgery

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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.

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“…The Deceased-Donor Study (DDS; ClinicalTrials.gov identifier: NCT01848249) is an ongoing multicenter, observational cohort study of deceased donors with chart reviews in their kidney recipients. The DDS cohort has been described in prior publications (18)(19)(20)(21)(22)(23). Briefly, five participating organ procurement organizations (OPOs) enrolled donors between May 2010 and December 2013.…”

Section: Study Population and Data Sourcementioning

confidence: 99%

Deceased-Donor Acute Kidney Injury and BK Polyomavirus in Kidney Transplant Recipients

Hall

Reese

Mansour

et al. 2021

CJASN

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Background and objectivesBK polyomavirus (BKV) infection commonly complicates kidney transplantation, contributing to morbidity and allograft failure. The virus is often donor-derived and influenced by ischemia-reperfusion processes and disruption of structural allograft integrity. We hypothesized that deceased-donor AKI associates with BKV infection in recipients.Design, setting, participants, & measurementsWe studied 1025 kidney recipients from 801 deceased donors transplanted between 2010 and 2013, at 13 academic centers. We fitted Cox proportional-hazards models for BKV DNAemia (detectable in recipient blood by clinical PCR testing) within 1 year post-transplantation, adjusting for donor AKI and other donor- and recipient-related factors. We validated findings from this prospective cohort with analyses for graft failure attributed to BKV within the Organ Procurement and Transplantation Network (OPTN) database.ResultsThe multicenter cohort mean kidney donor profile index was 49±27%, and 26% of donors had AKI. Mean recipient age was 54±13 years, and 25% developed BKV DNAemia. Donor AKI was associated with lower risk for BKV DNAemia (adjusted hazard ratio, 0.53; 95% confidence interval, 0.36 to 0.79). In the OPTN database, 22,537 (25%) patients received donor AKI kidneys, and 272 (0.3%) developed graft failure from BKV. The adjusted hazard ratio for the outcome with donor AKI was 0.7 (95% confidence interval, 0.52 to 0.95).ConclusionsIn a well-characterized, multicenter cohort, contrary to our hypothesis, deceased-donor AKI independently associated with lower risk for BKV DNAemia. Within the OPTN database, donor AKI was also associated with lower risk for graft failure attributed to BKV.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_03_10_CJN18101120_final.mp3

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The association of discharge decisions after deceased donor kidney transplantation with the risk of early readmission: Results from the deceased donor study

Abstract: These findings suggest that clinical decisions related to the timing of discharge and follow-up modify EHR risk after KT, independent of traditional risk factors.

Cited by 10 publications

References 50 publications

Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

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

Deceased-Donor Acute Kidney Injury and BK Polyomavirus in Kidney Transplant Recipients

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