Pulmonary and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA.
Good Shepard Penn Partners, Philadelphia, PA.
Transplantation. 2018 May;102(5):838-844. doi: 10.1097/TP.0000000000002101.
Unplanned rehospitalizations (UR) within 30 days of discharge are common after lung transplantation. It is unknown whether UR represents preventable gaps in care or necessary interventions for complex patients. The objective of this study was to assess the incidence, causes, risk factors, and preventability of UR after initial discharge after lung transplantation.
This was a single-center prospective cohort study. Subjects completed a modified short physical performance battery to assess frailty at listing and at initial hospital discharge after transplantation and the State-Trait Anxiety Inventory at discharge. For each UR, a study staff member and the patient's admitting or attending clinician used an ordinal scale (0, not; 1, possibly; 2, definitely preventable) to rate readmission preventability. A total sum score of 2 or higher defined a preventable UR.
Of the 90 enrolled patients, 30 (33.3%) had an UR. The single most common reasons were infection (7 [23.3%]) and atrial tachyarrhythmia (5 [16.7%]). Among the 30 URs, 9 (30.0%) were deemed preventable. Unplanned rehospitalization that happened before day 30 were more likely to be considered preventable than those between days 30 and 90 (30.0% versus 6.2%, P = 0.04). Discharge frailty, defined as short physical performance battery less than 6, was the only variable associated with UR on multivariable analysis (odds ratio, 3.4; 95% confidence interval, 1.1-11.8; P = 0.04).
Although clinicians do not rate the majority of UR after lung transplant as preventable, discharge frailty is associated with UR. Further research should identify whether modification of discharge frailty can reduce UR.
肺移植后 30 天内的非计划性再入院（UR）很常见。目前尚不清楚 UR 是代表护理中的可预防差距，还是复杂患者的必要干预。本研究的目的是评估肺移植初始出院后 UR 的发生率、原因、危险因素和可预防性。
这是一项单中心前瞻性队列研究。受试者在入组时和移植后初始出院时完成改良短体适能测试，以评估虚弱程度，并在出院时完成状态特质焦虑量表。对于每一次 UR，研究工作人员和患者的主治医生或主治住院医师会使用等级量表（0，非；1，可能；2，肯定可预防）来评估再入院的可预防性。总分 2 分或以上定义为可预防 UR。
在纳入的 90 名患者中，有 30 名（33.3%）发生 UR。最常见的单一原因是感染（7 [23.3%]）和房性心动过速（5 [16.7%]）。在 30 例 UR 中，有 9 例（30.0%）被认为是可预防的。在第 30 天之前发生的非计划性再入院比第 30 天至第 90 天之间发生的再入院更有可能被认为是可预防的（30.0%比 6.2%，P = 0.04）。在多变量分析中，出院时的虚弱状态（定义为短体适能测试小于 6）是与 UR 相关的唯一变量（优势比，3.4；95%置信区间，1.1-11.8；P = 0.04）。
尽管临床医生并未将大多数肺移植后的 UR 评为可预防，但出院时的虚弱状态与 UR 相关。进一步的研究应确定是否可以通过减轻出院时的虚弱状态来降低 UR。
