Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Prog Transplant. 2021 Jun;31(2):160-167. doi: 10.1177/15269248211003563. Epub 2021 Mar 24.
Kidney transplant recipients are at risk for complications resulting in early hospital readmission. This study sought to determine the incidences, risk factors, causes, and financial costs of early readmissions.
This single-centre cohort study included 1461 kidney recipients from 1 Jul 2004 to 31 Dec 2012, with at least 1-year follow-up. Early readmission was defined as hospitalization within 30 or 90-days postdischarge from transplant admission. Associations between various parameters and 30 and 90-days posttransplant were determined using multivariable Cox proportional hazards models. The hospital-associated costs of were assessed.
The rates of early readmission were 19.4% at 30 days and 26.8% at 90 days posttransplant. Mean cost per 30-day readmission was 11 606 CAD. Infectious complications were the most common reasons and resulted in the greatest cost burden. Factors associated with 30 and 90-days in multivariable models were recipient history of chronic lung disease (hazard ratio or HR 1.78 [95%CI: 1.14, 2.76] and HR 1.68 [1.14, 2.48], respectively), median time on dialysis (HR 1.07 [95% CI: 1.01, 1.13]and HR 1.06 [95% CI: 1.01, 1.11], respectively), being transplanted preemptively (HR 1.75 [95% CI: 1.07, 2.88] and HR 1.66 [95% CI: 1.07, 2.57], respectively), and having a transplant hospitalization lasting of and more than 11 days (HR 1.52 [95% CI: 1.01, 2.27] and HR 1.65 [95% CI: 1.16, 2.34], respectively).
Early hospital readmission after transplantation was common and costly. Strategies to reduce the burden of early hospital readmissions are needed for all patients.
肾移植受者有发生导致早期住院再入院并发症的风险。本研究旨在确定早期再入院的发生率、风险因素、原因和经济成本。
这项单中心队列研究纳入了 2004 年 7 月 1 日至 2012 年 12 月 31 日期间的 1461 名肾移植受者，所有受者均有至少 1 年的随访。早期再入院定义为移植入院后 30 天或 90 天内的住院治疗。使用多变量 Cox 比例风险模型确定各种参数与移植后 30 和 90 天的相关性。评估了与住院相关的费用。
30 天和 90 天的早期再入院率分别为 19.4%和 26.8%。30 天再入院的平均费用为 11606 加元。感染性并发症是最常见的原因，也是费用负担最大的原因。多变量模型中与 30 天和 90 天相关的因素包括受者慢性肺部疾病史（风险比或 HR 1.78 [95%CI：1.14，2.76]和 HR 1.68 [1.14，2.48]）、中位数透析时间（HR 1.07 [95%CI：1.01，1.13]和 HR 1.06 [95%CI：1.01，1.11]）、预先移植（HR 1.75 [95%CI：1.07，2.88]和 HR 1.66 [95%CI：1.07，2.57]）以及移植住院时间超过 11 天（HR 1.52 [95%CI：1.01，2.27]和 HR 1.65 [95%CI：1.16，2.34]）。
移植后早期住院再入院很常见且费用高昂。需要针对所有患者制定减少早期住院再入院负担的策略。
