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

Meera Nair Harhay, Yaqi Jia, Heather Thiessen Philbrook, Behdad Besharatian, Ramnika Gumber, Francis L. Weng, Isaac E. Hall, Mona Doshi, Bernd Schroppel, Chirag Parikh, Peter P. Reese

Research output: Contribution to journalArticle

Abstract

Background: Kidney transplant (KT) recipients experience high rates of early (≤30 days) hospital readmission (EHR) after KT, and existing studies provide limited data on modifiable discharge factors that may mitigate EHR risk. Methods: We performed a retrospective cohort study of 468 adult deceased donor KT recipients transplanted between 4/2010 and 11/2013 at 5 United States transplant centers. We fit multivariable mixed effects models to assess the association of two potentially modifiable discharge factors with the probability of EHR after KT: (i) weekend discharge and (ii) days to first scheduled follow-up. Results: Among 468 KT recipients, 38% (n = 178) experienced EHR after KT. In fully adjusted analyses, compared to weekday discharges, KT recipients discharged on the weekend had a 29% lower risk of EHR (adjusted odds ratio [aOR] 0.71, 95% confidence interval [CI] 0.41-0.94). Compared to follow-up within 2 days of discharge, KT recipients with follow-up within 3 to 6 days had a 28% higher probability of EHR (aOR 1.28, 95% CI 1.13-1.45). Conclusions: 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.

Original languageEnglish (US)
Article numbere13215
JournalClinical Transplantation
Volume32
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Kidney Transplantation
Tissue Donors
Kidney
Transplants
Odds Ratio
Confidence Intervals
Patient Readmission
Cohort Studies
Retrospective Studies
Transplant Recipients

Keywords

  • hospitalization
  • kidney
  • readmission

ASJC Scopus subject areas

  • Transplantation

Cite this

The association of discharge decisions after deceased donor kidney transplantation with the risk of early readmission : Results from the deceased donor study. / Harhay, Meera Nair; Jia, Yaqi; Thiessen Philbrook, Heather; Besharatian, Behdad; Gumber, Ramnika; Weng, Francis L.; Hall, Isaac E.; Doshi, Mona; Schroppel, Bernd; Parikh, Chirag; Reese, Peter P.

In: Clinical Transplantation, Vol. 32, No. 4, e13215, 01.04.2018.

Research output: Contribution to journalArticle

Harhay, Meera Nair ; Jia, Yaqi ; Thiessen Philbrook, Heather ; Besharatian, Behdad ; Gumber, Ramnika ; Weng, Francis L. ; Hall, Isaac E. ; Doshi, Mona ; Schroppel, Bernd ; Parikh, Chirag ; Reese, Peter P. / The association of discharge decisions after deceased donor kidney transplantation with the risk of early readmission : Results from the deceased donor study. In: Clinical Transplantation. 2018 ; Vol. 32, No. 4.
@article{a1d8c9ccf11f438ab9bf7d28f36e9c3f,
title = "The association of discharge decisions after deceased donor kidney transplantation with the risk of early readmission: Results from the deceased donor study",
abstract = "Background: Kidney transplant (KT) recipients experience high rates of early (≤30 days) hospital readmission (EHR) after KT, and existing studies provide limited data on modifiable discharge factors that may mitigate EHR risk. Methods: We performed a retrospective cohort study of 468 adult deceased donor KT recipients transplanted between 4/2010 and 11/2013 at 5 United States transplant centers. We fit multivariable mixed effects models to assess the association of two potentially modifiable discharge factors with the probability of EHR after KT: (i) weekend discharge and (ii) days to first scheduled follow-up. Results: Among 468 KT recipients, 38{\%} (n = 178) experienced EHR after KT. In fully adjusted analyses, compared to weekday discharges, KT recipients discharged on the weekend had a 29{\%} lower risk of EHR (adjusted odds ratio [aOR] 0.71, 95{\%} confidence interval [CI] 0.41-0.94). Compared to follow-up within 2 days of discharge, KT recipients with follow-up within 3 to 6 days had a 28{\%} higher probability of EHR (aOR 1.28, 95{\%} CI 1.13-1.45). Conclusions: 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.",
keywords = "hospitalization, kidney, readmission",
author = "Harhay, {Meera Nair} and Yaqi Jia and {Thiessen Philbrook}, Heather and Behdad Besharatian and Ramnika Gumber and Weng, {Francis L.} and Hall, {Isaac E.} and Mona Doshi and Bernd Schroppel and Chirag Parikh and Reese, {Peter P.}",
year = "2018",
month = "4",
day = "1",
doi = "10.1111/ctr.13215",
language = "English (US)",
volume = "32",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - The association of discharge decisions after deceased donor kidney transplantation with the risk of early readmission

T2 - Results from the deceased donor study

AU - Harhay, Meera Nair

AU - Jia, Yaqi

AU - Thiessen Philbrook, Heather

AU - Besharatian, Behdad

AU - Gumber, Ramnika

AU - Weng, Francis L.

AU - Hall, Isaac E.

AU - Doshi, Mona

AU - Schroppel, Bernd

AU - Parikh, Chirag

AU - Reese, Peter P.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background: Kidney transplant (KT) recipients experience high rates of early (≤30 days) hospital readmission (EHR) after KT, and existing studies provide limited data on modifiable discharge factors that may mitigate EHR risk. Methods: We performed a retrospective cohort study of 468 adult deceased donor KT recipients transplanted between 4/2010 and 11/2013 at 5 United States transplant centers. We fit multivariable mixed effects models to assess the association of two potentially modifiable discharge factors with the probability of EHR after KT: (i) weekend discharge and (ii) days to first scheduled follow-up. Results: Among 468 KT recipients, 38% (n = 178) experienced EHR after KT. In fully adjusted analyses, compared to weekday discharges, KT recipients discharged on the weekend had a 29% lower risk of EHR (adjusted odds ratio [aOR] 0.71, 95% confidence interval [CI] 0.41-0.94). Compared to follow-up within 2 days of discharge, KT recipients with follow-up within 3 to 6 days had a 28% higher probability of EHR (aOR 1.28, 95% CI 1.13-1.45). Conclusions: 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.

AB - Background: Kidney transplant (KT) recipients experience high rates of early (≤30 days) hospital readmission (EHR) after KT, and existing studies provide limited data on modifiable discharge factors that may mitigate EHR risk. Methods: We performed a retrospective cohort study of 468 adult deceased donor KT recipients transplanted between 4/2010 and 11/2013 at 5 United States transplant centers. We fit multivariable mixed effects models to assess the association of two potentially modifiable discharge factors with the probability of EHR after KT: (i) weekend discharge and (ii) days to first scheduled follow-up. Results: Among 468 KT recipients, 38% (n = 178) experienced EHR after KT. In fully adjusted analyses, compared to weekday discharges, KT recipients discharged on the weekend had a 29% lower risk of EHR (adjusted odds ratio [aOR] 0.71, 95% confidence interval [CI] 0.41-0.94). Compared to follow-up within 2 days of discharge, KT recipients with follow-up within 3 to 6 days had a 28% higher probability of EHR (aOR 1.28, 95% CI 1.13-1.45). Conclusions: 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.

KW - hospitalization

KW - kidney

KW - readmission

UR - http://www.scopus.com/inward/record.url?scp=85042638500&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042638500&partnerID=8YFLogxK

U2 - 10.1111/ctr.13215

DO - 10.1111/ctr.13215

M3 - Article

C2 - 29393541

AN - SCOPUS:85042638500

VL - 32

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

IS - 4

M1 - e13215

ER -