Naderi M, Aslani J, Hashemi M, Assari S, Amini M, Pourfarziani V
Nephrology/Urology Research Center (NURC), Baqiyatallah Medical Sciences University, Tehran, Iran.
Transplant Proc. 2007 May;39(4):978-80. doi: 10.1016/j.transproceed.2007.03.081.
Although some studies have described rehospitalization after transplantation, few have focused on risk factors and consequences of prolonged hospital stay. Our goal was to determine the causes, risk factors, and outcomes of prolonged rehospitalizations after renal transplantation.
In this retrospective study, 574 randomly selected rehospitalization records of kidney transplant recipients were reviewed from 1994 to 2006. Admissions were divided into group 1, prolonged stay (length of stay >14 days, n=149), and group II, short stay (length of stay <or=14 days, n=425). Demographic data, cause of end-stage renal disease (ESRD), cause of readmission, ICU admission, time interval between transplantation and rehospitalization, costs, and in-patient mortality were compared between the two groups.
Mean (+/-SD) hospital stay was 10.6 +/- 9.8 days. Median hospital stay was 5 days for renal stones, 7 days for surgical complications, 8 days for malignancy, 9 days for infection, and 10 days for renal dysfunction. We found higher rates of ESRD due to diabetes in group I (28% vs. 15.4%; P=.006). Admissions due to infections (56.4% vs 42.4%; P=.003) or renal dysfunctions (55% vs 41.4%; P=.004) were the cause of higher proportions of total hospitalizations with prolonged stay. Prolonged stay also correlated with higher ICU admissions (8.8% vs 2.8%; P=.002) and mortality (6.7% vs 3.05%; P=.001). Mean total hospital cost for short versus prolonged hospitalizations were US$ 586 versus US$ 2750, respectively.
In this study, we found that prolonged hospital stays accounted for >62% of all hospital costs; however, they comprised only 26% of the patients. High-risk kidney transplant recipients for prolonged hospitalizations should be closely observed for infections and graft rejection.
尽管一些研究描述了移植后的再次住院情况，但很少有研究关注延长住院时间的危险因素及后果。我们的目标是确定肾移植后再次住院时间延长的原因、危险因素及结局。
在这项回顾性研究中，我们回顾了1994年至2006年随机选取的574例肾移植受者的再次住院记录。入院情况分为两组，第1组为住院时间延长组（住院时间>14天，n = 149），第2组为住院时间短组（住院时间≤14天，n = 425）。比较了两组的人口统计学数据、终末期肾病（ESRD）病因、再次入院原因、入住重症监护病房（ICU）情况、移植与再次住院之间的时间间隔、费用及住院死亡率。
平均（±标准差）住院时间为10.6±9.8天。肾结石患者的中位住院时间为5天，手术并发症患者为7天，恶性肿瘤患者为8天，感染患者为9天，肾功能不全患者为10天。我们发现第1组中因糖尿病导致ESRD的比例更高（28%对15.4%；P = 0.006）。因感染（56.4%对42.4%；P = 0.003）或肾功能不全（55%对41.4%；P = 0.004）导致的再次入院是住院时间延长的总住院病例中所占比例较高的原因。住院时间延长还与更高的ICU入住率（8.8%对2.8%；P = 0.002）和死亡率（6.7%对3.05%；P = 0.001）相关。短期与长期住院的平均总住院费用分别为586美元和2750美元。
在本研究中，我们发现住院时间延长占所有住院费用的>62%；然而，这些患者仅占患者总数的26%。对于住院时间可能延长的高危肾移植受者，应密切观察其感染及移植物排斥情况。
