Health care utilization and consequences of readmission in the first year after lung transplantation

作者：Mollberg Nathan M^*; Howell Eric; Vanderhoff David I; Cheng Aaron; Mulligan Michael S

来源：Journal of Heart and Lung Transplantation, 2017, 36(4): 443-450.

DOI：10.1016/j.healun.2016.09.015

• lung transplant
• readmission
• outcomes
• survival
• morbidity

BACKGROUND: Hospital readmissions are costly and have become a focus for quality improvement. We aimed to determine risk factors, rate, and outcomes of readmissions within the first year after lung transplantation and the potential impact on patient survival.
METHODS: A retrospective cohort study of all lung transplant recipients >= 18 years old who had undergone initial transplantation (2004-2013) at a single center was conducted. Logistic regression was used to identify independent predictors of readmission for patients who survived hospitalization. Cox regression was used to explore the relationship between readmission and long-term risk of death, while adjusting for potential confounders for patients who survived the first year.
RESULTS: During the study period, 412 patients met inclusion criteria for the readmission analysis. There were 276 patients (67%) readmitted within 1 year after lung transplantation for a total of 609 readmissions (average +/- SD, 1.5 +/- 2). Average length of readmission stay was 6 days +/- 7, with 44% of readmissions lasting <= 3 days. Airway complications were found to be a significant risk factor for readmission (odds ratio, 4.18; 95% confidence interval, 1.78-9.54; p = 0.001). After adjustment, the overall risk of death was significantly higher with each readmission during the first year (hazard ratio, 1.22; 95% confidence interval, 1.13-1.31, p < 0.0001).
CONCLUSIONS: Most patients who survive the first post-operative year experience at least 1 readmission, with patients who experience airway complications at particular risk. Patients discharged to inpatient rehabilitation were less likely to be readmitted. The cumulative burden of multiple readmissions is associated with worse long-term survival.

• 出版日期2017-4