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. 2016 Feb;16(2):541-9.
doi: 10.1111/ajt.13485. Epub 2015 Oct 16.

Early Hospital Readmission After Simultaneous Pancreas-Kidney Transplantation: Patient and Center-Level Factors

E A King  1 , L M Kucirka  1   2 , M A McAdams-DeMarco  1   2 , A B Massie  1   2 , F Al Ammary  3 , R Ahmed  1 , M E Grams  3 , D L Segev  1   2
Affiliations

Early Hospital Readmission After Simultaneous Pancreas-Kidney Transplantation: Patient and Center-Level Factors

E A King et al. Am J Transplant. 2016 Feb.

Abstract

Early hospital readmission is associated with increased morbidity, mortality, and cost. Following simultaneous pancreas-kidney transplantation, rates of readmission and risk factors for readmission are unknown. We used United States Renal Data System data to study 3643 adult primary first-time simultaneous pancreas-kidney recipients from December 1, 1999 to October 31, 2011. Early hospital readmission was any hospitalization within 30 days of discharge. Modified Poisson regression was used to determine the association between readmission and patient-level factors. Empirical Bayes statistics were used to determine the variation attributable to center-level factors. The incidence of readmission was 55.5%. Each decade increase in age was associated with an 11% lower risk of readmission to age 40, beyond which there was no association. Donor African-American race was associated with a 13% higher risk of readmission. Each day increase in length of stay was associated with a 2% higher risk of readmission until 14 days, beyond which each day increase was associated with a 1% reduction in the risk of readmission. Center-level factors were not associated with readmission. The high incidence of early hospital readmission following simultaneous pancreas-kidney transplant may reflect clinical complexity rather than poor quality of care.

Keywords: clinical decision-making; clinical research/practice; health services and outcomes research; hospital readmission; pancreas/simultaneous pancreas-kidney transplantation; quality of care/care delivery.

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Conflict of interest statement

DISCLOSURE

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1
Figure 1. Ratio of observed to expected probability of early hospital readmission after simultaneous pancreas-kidney transplantation for each transplant center
The observed probability of EHR was calculated for each center. Based on each center’s case mix an expected probability of EHR was derived from the final model. Each dot represents the ratio of observed to expected probability of EHR for a given transplant center. A center that readmits exactly as many patients as expected falls on the reference line. Those that admit less than expected fall below the reference line and those that admit more than expected fall above the reference line.
Figure 2
Figure 2. Relative risk of early hospital readmission after simultaneous pancreas-kidney transplantation by transplant center compared to national average
Each dot represents the relative risk of EHR for each transplant center in the United States, with 95% confidence interval. The confidence interval for all but one of the transplant centers overlaps the reference line, which represents the national average for EHR following SPK.
See this image and copyright information in PMC

References

    1. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare Fee-for-Service Program. N Engl J Med. 2009;360:1418–1428. - PubMed
    1. Axon RN, Williams MV. Hospital Readmission as an Accountability Measure. JAMA. 2011;305(5):504–505. - PubMed
    1. James J, Hall K, Joynt KE, et al. Health Policy Brief: Medicare Hospital Readmissions Reduction Program. Health Aff. 2013;30(5)
    1. Hannan EL, Zhong Y, Lahey SJ, et al. 30-day readmissions after coronary artery bypass graft surgery in New York state. JACC Cardiovasc Interv. 2011;4:569–576. - PubMed
    1. Goodney PP, Stukel TA, Lucas FL, et al. Hospital volume, length of stay, and readmission rates in high-risk surgery. Ann Surg. 2003;238:161–167. - PMC - PubMed

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