Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada.
Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Transplantation. 2018 Apr;102(4):e171-e179. doi: 10.1097/TP.0000000000002036.
Early hospital readmission (EHR) is associated with morbidity, mortality, and significant healthcare costs. However, trends over time in EHR events in kidney transplant recipients have not been examined. We conducted a population-based cohort study using linked healthcare databases from Ontario, Canada, to determine whether the EHR incidence has changed from 2002 to 2014 in kidney transplant recipients.
We defined EHR as an unplanned admission for any reason to an acute care hospital within 30 days of being discharged from the hospital for transplantation; admissions for elective procedures were excluded.
We included 5437 kidney transplant recipients. More recently transplanted recipients (2011 to 2014 vs 2002 to 2004) were older and more likely to have coronary artery disease. A total of 1128 (20.7%) kidney transplant recipients experienced an EHR. There was no trend in EHR across eras with a 30-day cumulative incidence of 23.0%, 21.4%, 18.4%, and 21.0% (P for trend =0.197) for the years 2002 to 2004, 2005 to 2007, 2008 to 2010, and 2011 to 2014, respectively. In the multivariable Cox proportional hazards model, we found no association between era of transplant and EHR. When examining variation in EHR across the 6 adult transplant centers, we found the 30-day cumulative incidence varied significantly from 15.5% to 27.1% (P < 0.001).
One in 5 kidney transplant recipients will experience an EHR; however, an increase in EHR over time has not been observed despite increasing recipient age and comorbidities.
早期医院再入院（EHR）与发病率、死亡率和显著的医疗保健成本相关。然而，在肾移植受者中，EHR 事件随时间的变化趋势尚未得到检验。我们进行了一项基于人群的队列研究，使用加拿大安大略省的链接医疗保健数据库，以确定肾移植受者的 EHR 发生率是否从 2002 年到 2014 年发生了变化。
我们将 EHR 定义为因任何原因在从医院出院后 30 天内再次入院接受急性护理医院治疗；排除因选择性手术而入院的患者。
我们纳入了 5437 名肾移植受者。最近接受移植的受者（2011 年至 2014 年与 2002 年至 2004 年）年龄较大，更有可能患有冠状动脉疾病。共有 1128 名（20.7%）肾移植受者发生 EHR。各时期 EHR 没有趋势，2002 年至 2004 年、2005 年至 2007 年、2008 年至 2010 年和 2011 年至 2014 年 30 天累计发生率分别为 23.0%、21.4%、18.4%和 21.0%（趋势 P 值=0.197）。在多变量 Cox 比例风险模型中，我们发现移植年代与 EHR 之间没有关联。当我们检查 6 个成人移植中心之间 EHR 的变化时，我们发现 30 天累计发生率从 15.5%到 27.1%差异显著（P<0.001）。
每 5 名肾移植受者中就有 1 名会经历 EHR；然而，尽管受者年龄和合并症增加，但随着时间的推移，EHR 并未增加。
