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. 2019 Nov;23(7):e13561.
doi: 10.1111/petr.13561. Epub 2019 Sep 4.

Hospital readmission following pediatric heart transplantation

William T Mahle  1 , Kristen L Mason  2 , Anne I Dipchand  3 , Marc Richmond  4 , Brian Feingold  5 , Charles E Canter  6 , Daphne T Hsu  7 , Tajinder P Singh  8 , Robert E Shaddy  9 , Brian D Armstrong  2 , Adriana Zeevi  10 , David N Iklé  2 , Helena Diop  11 , Jonah Odim  11 , Steven A Webber  12 ; CTOTC-04 Investigators
Affiliations

Hospital readmission following pediatric heart transplantation

William T Mahle et al. Pediatr Transplant. 2019 Nov.

Abstract

The frequency, indications, and outcomes for readmission following pediatric heart transplantation are poorly characterized. A better understanding of this phenomenon will help guide strategies to address the causes of readmission. Data from the Clinical Trials in Organ Transplantation for Children (CTOTC-04) multi-institutional collaborative study were utilized to determine incidence of, and risk factors for, hospital readmission within 30 days and 1 year from initial hospital discharge. Among 240 transplants at 8 centers, 227 subjects were discharged and had follow-up. 129 subjects (56.8%) were readmitted within one year; 71 had two or more readmissions. The 30-day and 1-year freedom from readmission were 70.5% (CI: 64.1%, 76.0%) and 42.2% (CI: 35.7%, 48.7%), respectively. The most common indications for readmissions were infection followed by rejection and fever without confirmed infection, accounting for 25.0%, 10.6%, and 6.2% of readmissions, respectively. Factors independently associated with increased risk of first readmission within 1 year (Cox proportional hazard model) were as follows: transplant in infancy (P = .05), longer transplant hospitalization (P = .04), lower UNOS urgency status (2/IB vs 1A) at transplant (P = .04), and Hispanic ethnicity (P = .05). Hospital readmission occurs frequently in the first year following discharge after heart transplantation with highest risk in the first 30 days. Infection is more common than rejection as cause for readmission, with death during readmission being rare. A number of patient factors are associated with higher risk of readmission. A fuller understanding of these risk factors may help tailor strategies to reduce unnecessary hospital readmission.

Keywords: pediatric heart transplantation; readmission.

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Figures

FIGURE 1
FIGURE 1
Histogram showing the distribution of the length of the initial transplant hospital stay
FIGURE 2
FIGURE 2
Probability of freedom from hospital readmission in the first year following the initial transplant hospital discharge with 95% confidence interval (A) and corresponding hazard function (B). The number of participants at risk is presented at select time points along the x-axis. Censored data are shown as circles
FIGURE 3
FIGURE 3
Risk factors for first hospital readmission within 30 days (A) and 1 year (B) of initial transplant hospital discharge using Cox proportional hazards model
See this image and copyright information in PMC

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