Three in 10 patients receiving a kidney transplant require readmission to the hospital within 30 days of discharge following surgery, according to a Johns Hopkins analysis of six years of national data.
The findings, published online in the American Journal of Transplantation, suggest more needs to be done to manage patients outside the hospital to keep them from costly and potentially preventable return visits. Readmissions are said to cost the U.S. health care system $25 billion a year. The Centers for Medicare and Medicaid Services has begun the process of decreasing reimbursements to hospitals with high readmission rates, using readmissions as a surrogate measure of hospital quality.
"We need to be aware that kidney transplant recipients have an extremely high risk of returning to the hospital in the first 30 days after discharge, and that readmissions may very well be prevented by putting in place better systems for outpatient management," says study leader Dorry L. Segev, M.D., Ph.D., an associate professor of surgery at the Johns Hopkins University School of Medicine. "Some patients just need more intense monitoring."
Segev and his colleagues examined data provided by the Organ Procurement and Transplantation Network, Medicare, and the United States Renal Data System from more than 32,000 patients who received kidney transplants in U.S. hospitals between Jan. 1, 2000 and Dec. 31, 2005. While 31 percent of transplant recipients required readmission within 30 days, the percent of patients returning varied by hospital, from 18 percent to nearly 50 percent, a variation that could not be accounted for by conventional issues of center volume or demographics.
Age, race, body mass index, diabetes, heart disease and several other factors were associated with early hospital readmission. African-Americans had an 11 percent increased risk of readmission, and obese patients had a 15 percent increased risk, while diabetic women were at a 29 percent increased risk. Interestingly, those patients who stayed in the hospital for five or more days at the time of their transplants were more likely to be readmitted within 30 days. Segev says this may be a sign that the more complex cases early on appear to remain complex and more likely to require additional care.