Early Hospital Readmission After Kidney Transplantation: Patient and Center-Level Associations
Early Hospital Readmission After Kidney Transplantation: Patient and Center-Level Associations
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DOI：
10.1111/j.1600-6143.2012.04285.x
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发表时间：
2012-12-01
影响因子：
8.8
通讯作者：
Segev, D. L.
中科院分区：
文献类型：
--
作者：
McAdams-DeMarco, M. A.;Grams, M. E.;Segev, D. L.
早期再入院（EHR）与发病率、成本和护理过渡错误增加相关。我们试图量化肾移植（KT）后EHR的发生率和风险因素。我们研究了32，961名通过美国肾脏数据系统与医疗保险索赔相关的医疗保险初级KT接受者（20002005）。EHR定义为KT后首次出院30天内至少住院一次。EHR与受体和移植因素之间的关联采用Poisson回归进行了探讨;分层模型用于解释研究中心水平的差异。总体EHR率为31%，确定了19个与EHR相关的独立患者水平因素：受体因素包括年龄较大，非裔美国人种族和各种合并症;移植因素包括ECD，住院时间和缺乏诱导治疗。各中心EHR的未调整率范围为18%至47%，但传统的中心水平因素（非裔美国人百分比，年龄> 60岁的百分比，死亡供体百分比和扩展标准供体百分比）与EHR无关。然而，中等总量和平均住院时间与EHR风险增加相关。更好地识别KT术后早期再入院风险的患者可以指导出院计划和移植后早期门诊监测。
Early hospital readmission (EHR) is associated with increased morbidity, costs and transition-of-care errors. We sought to quantify rates of and risk factors for EHR after kidney transplantation (KT). We studied 32 961 Medicare primary KT recipients (20002005) linked to Medicare claims through the United States Renal Data System. EHR was defined as at least one hospitalization within 30 days of initial discharge after KT. The association between EHR and recipient and transplant factors was explored using Poisson regression; hierarchical modeling was used to account for study center-level differences. The overall EHR rate was 31%, and 19 independent patient-level factors associated with EHR were identified: recipient factors included older age, African American race and various comorbidities; transplant factors included ECD, length of stay and lack of induction therapy. The unadjusted rate of EHR by center ranged from 18% to 47%, but conventional center-level factors (percent African American, percent age > 60, percent deceased donor and percent expanded criteria donor) were not associated with EHR. However, intermediate total volume and average length of stay were associated with increased EHR risk. Better identification of patients at risk for early hospital readmission following KT may guide discharge planning and early posttransplant outpatient monitoring.