Lushaj Entela, Julliard Walker, Akhter Shahab, Leverson Glen, Maloney James, Cornwell Richard D, Meyer Keith C, DeOliveira Nilto
Department of Surgery, Section of Cardiothoracic Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin.
Department of Medicine, Section of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin.
Ann Thorac Surg. 2016 Aug;102(2):378-84. doi: 10.1016/j.athoracsur.2016.02.083. Epub 2016 May 4.
Adverse events that require hospital readmission frequently occur long after lung transplantation (LT) that has been successfully performed. We sought to identify the causes and rate of unplanned readmissions after LT and to determine whether unplanned readmissions have a significant impact on post-LT survival.
We retrospectively reviewed the outcomes in 174 LT recipients who underwent LT at our center from June 2005 to May 2014. The median follow-up period was 38 months (range, 17 to 72 months).
One hundred sixty (92%) of the 174 recipients were readmitted 854 times (5.3 times per patient). The median time to first readmission was 71 days (interquartile range [IQR], 28 to 240 days), and the median hospital length of stay at readmission was 3 days (IQR, 2 to 6 days). Freedom from first readmission was observed for 65% of patients at 1 month, 48% at 3 months, 43% at 6 months, and 26% at 12 months. Gender, lung allocation score, body surface area, year of transplantation, air leak longer than 5 days after operation, and allograft function were risk factors for readmission. The causes of readmission included infections (33%), respiratory adverse events (18%), rejection (15%), gastrointestinal events (15%), renal dysfunction (5%), and cardiac events (4%). Patients who died were found to have had early readmissions (p = 0.04) and more frequent readmissions (p = 0.001).
The first year after LT remains a high-risk period for unplanned readmissions regardless of pretransplantation diagnosis. Readmissions soon after discharge at index hospitalization and multiple readmissions are associated with an increased risk of mortality.
在成功进行肺移植（LT）后很长时间，经常会发生需要再次入院治疗的不良事件。我们试图确定LT后计划外再入院的原因和发生率，并确定计划外再入院是否对LT后的生存有重大影响。
我们回顾性分析了2005年6月至2014年5月在本中心接受LT的174例LT受者的结局。中位随访期为38个月（范围17至72个月）。
174例受者中有160例（92%）再次入院854次（每位患者5.3次）。首次再入院的中位时间为71天（四分位间距[IQR]，28至240天），再入院时的中位住院时间为3天（IQR，2至6天）。1个月时65%的患者未发生首次再入院，3个月时为48%，6个月时为43%，12个月时为26%。性别、肺分配评分、体表面积、移植年份、术后漏气超过5天以及移植肺功能是再入院的危险因素。再入院原因包括感染（33%）、呼吸道不良事件（18%）、排斥反应（15%）、胃肠道事件（15%）、肾功能不全（5%）和心脏事件（4%）。发现死亡患者有早期再入院情况（p = 0.04）且再入院更频繁（p = 0.001）。
无论移植前诊断如何，LT后的第一年仍然是计划外再入院的高危期。首次住院出院后不久的再入院以及多次再入院与死亡风险增加相关。
