Outcomes and Health Care Utilization After Early Hospital Dismissal in Kidney Transplantation
Autor: | Esteban Calderon, James M. Chang, Amit K. Mathur, Ananth Srinivasan, Raymond L. Heilman, Yu Hui H. Chang, Emmanouil Giorgakis, Kunam S. Reddy, Cristine S. Velazco, Adyr A. Moss, Hasan Khamash |
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Rok vydání: | 2020 |
Předmět: |
Adult
Male medicine.medical_specialty Time Factors Renal function Single Center Living donor 03 medical and health sciences 0302 clinical medicine Dismissal Internal medicine Health care Humans Medicine Kidney transplantation Aged Retrospective Studies Kidney business.industry Length of Stay Middle Aged Patient Acceptance of Health Care medicine.disease Kidney Transplantation Patient Discharge Treatment Outcome medicine.anatomical_structure 030220 oncology & carcinogenesis Cohort Female 030211 gastroenterology & hepatology Surgery business |
Zdroj: | Annals of Surgery. 275:e511-e519 |
ISSN: | 1528-1140 0003-4932 |
Popis: | OBJECTIVE To understand whether reduced lengths of stay after kidney transplantation were associated with excess health care utilization in the first 90 days or long-term graft and patient survival outcomes. BACKGROUND Reducing length of stay after kidney transplant has an unknown effect on post-transplant health care utilization. We studied this association in a cohort of 1001 consecutive kidney transplants. METHODS We retrospectively reviewed 2011-2015 data from a prospectively-maintained kidney transplant database from a single center. RESULTS A total of 1001 patients underwent kidney transplant, and were dismissed from the hospital in 3 groups: Early [≤2 days] (19.8%), Normal [3-7 days] (79.4%) and Late [>7 days] (3.8%). 34.8% of patients had living donor transplants (Early 51%, Normal 31.4%, Late 18.4%, P < 0.001). Early patients had lower delayed graft function rates (Early 19.2%, Normal 32%, Late73.7%, P = 0.001). By the hospital dismissal group, there were no differences in readmissions or emergency room visits at 30 or 90 days. Glomerular filtration rate at 12 months and rates of biopsy-proven acute rejection were also similar between groups. The timing of hospital dismissal was not associated with the risk-adjusted likelihood of readmission. Early and Normal patients had similar graft and patient survival. Late dismissal patients, who had higher rates of cardiovascular complications, had significantly higher late mortality versus Normal dismissal patients in unadjusted and risk-adjusted models. CONCLUSION Dismissing patients from the hospital 2 days after kidney transplant is safe, feasible, and improves value. It is not associated with excess health care utilization or worse short or long-term transplant outcomes. |
Databáze: | OpenAIRE |
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