It is common for patients to be readmitted to the hospital soon after getting a kidney transplant. But it's still unclear what causes these rehospitalizations and if they can be avoided.
A recent study found that early rehospitalizations after kidney transplant surgery were associated with longer initial stay at the hospital, amount of years spent on the organ waiting list and a weekend discharge.
The researchers suggested that health professionals should use these predictors of rehospitalizations to identify and assist patients who may be at risk for future complications.
The lead author of this study was Michael Harhay, MA, MPH, from the Center for Clinical Epidemiology and Biostatistics and the Renal Division of the Department of Medicine at the University of Pennsylvania in Philadelphia, Pennsylvania.
The study population included 753 adults over the age of 18 who got a kidney transplant between January 1, 2003 and December 31, 2007. The average age was 51 years old, 34 percent were black and 64 percent were male.
A total of 32 percent of the participants were rehospitalized within 30 days after the transplant — this is considered an early rehospitalization. While 24 percent of the participants had one early rehospitalization, 6 percent had two and 2 percent had three within the 30-day period.
The average time until first early rehospitalization was seven days. The participants were followed-up for an average of six years.
The researchers analyzed the rehospitalizations and determined four different categories of reasons for rehospitalization:
- Unplanned and related to kidney transplant
- Unplanned and unrelated to kidney transplant
- Planned and related to kidney transplant
- Planned and unrelated to kidney transplant
Then the researchers determined whether or not each rehospitalization could have been prevented.
The findings showed that 90 percent of the participants had unplanned rehospitalizations, and 94 percent of these unplanned rehospitalizations were related to the kidney transplant.
Only 9 percent of the rehospitalizations were planned and related to the kidney transplant. There were only two patients who had planned rehospitalizations unrelated to the kidney transplant.
The researchers found that the leading causes of the unplanned rehospitalizations were complications from the operation. A total of 15 percent were due to blood clots and pain, 14 percent were due to the body rejecting the kidney, 11 percent were due to fluids in the blood being too high or too low, 11 percent were due to bodily infection, and 3 percent were due to surgical wound infections.
Only 19 of the rehospitalizations were found to be preventable; this represents 9 percent of all the unplanned rehospitalizations and 3 percent of the entire study population.
The findings revealed that the rehospitalized patients waited an average of 1.75 years longer on the transplant wait list compared to the patients who were not rehospitalized.
The researchers also found that the rehospitalized patients had an average length of stay of 4.8 days, compared to 4.0 days for the group that was not rehospitalized. The odds for rehospitalization were 1.42 times greater if a patient's length of stay was over 4.5 days.
A total of 30 percent of the rehospitalized group and 23 percent of the group that was not rehospitalized were discharged on the weekend. This meant that there were 1.59 times greater odds of rehospitalization if a patient was discharged from the hospital on the weekend.
Overall, the researchers found that a weekend discharge was associated with a 65 percent increased risk of having one early rehospitalization, and patients who had a longer initial length of stay were more than twice as likely to have two or more early rehospitalizations.
The researchers suggested that these factors may be used for predicting future rehospitalizations.
The other variables were not found to significantly affect the chance of rehospitalization.
The authors mentioned a few limitations of their study.
First, because the study only included one hospital, the findings may not be applicable to the general population. Second, the researchers did not account for outside contributing factors such as level of education or social support.
Third, because the researchers used past data, they were limited in their ability to determine if the rehospitalizations could have been prevented or not. Lastly, the researchers did not consider medical history of other conditions previously found to be risk factors for rehospitalization, such as cancer and heart disease.
This study was published online on October 28 in the American Journal of Transplantation.
The National Institute of Diabetes and Digestive and Kidney Disease provided funding.