Pre-kidney transplant lower extremity impairment and transplant length of stay: A time-to-discharge analysis of a prospective cohort study

Anthony J. Nastasi, Tyler S. Bryant, Jimmy T. Le, Jennifer Schrack, Hao Ying, Christine E. Haugen, Marlís González Fernández, Dorry L. Segev, Mara A. McAdams-Demarco

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Few objective tests can be performed at admission for kidney transplantation [KT] to discern risk of increased length of stay [LOS], which is important for patient counseling and is associated with increased costs and mortality. The short physical performance battery [SPPB] is an easily administered, potentially modifiable, 3-part test of lower extremity function. SPPB score is associated with longer hospital LOS in older adults, and may provide similar utility in KT recipients given that ESRD is a disease of accelerated aging. The aim of this study was to characterize the association between SPPB-derived lower extremity function and LOS. Methods: The SPPB was administered at KT admission in a prospective cohort of 595 recipients (8/2009-6/2016). The independent association between SPPB impairment (score ≤ 10) and LOS was tested with an adjusted conventional generalized gamma parametric survival model. Results: Impaired recipients experienced longer LOS (median: 10 vs. 8 days; P < 0.001) with the greatest difference in percent discharged on day 10 (impaired: 54.5%, unimpaired: 73.3%). Discharge typically took 13% longer in the impaired group (relative time = 1.13; 95%CI: 1.05, 1.21, P = 0.001). Discharge for impaired recipients compared to unimpaired was least likely at day 5 (hazard ratio = 0.71; 95% CI:0.68, 0.74, P < 0.001). No differences in the SPPB impairment-LOS relationship were found by age (interaction P = 0.74). Conclusions: Pre-KT SPPB impairment was independently associated with longer LOS regardless of age, indicating that it is a useful, objective tool for pre-KT risk assessment in younger and older recipients that may help inform discharge planning.

Original languageEnglish (US)
Article number246
JournalBMC geriatrics
Volume18
Issue number1
DOIs
StatePublished - Oct 19 2018

Keywords

  • Kidney transplantation
  • Length of stay
  • Survival analysis

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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