Date: Tuesday, June 14, 2016
Session Name: Concurrent Session: Kidney: Length of Stay/Readmission
Session Time: 2:30pm-4:00pm
Presentation Time: 3:18pm-3:30pm
Location: Room 302
Background: Reducing kidney transplant length of stay is a priority for many stakeholders. We aimed to determine whether very early discharge – on or before postoperative day two – affects complications, health care utilization, or long-term outcomes.
Methods: 869 consecutive kidney transplant recipients (2011-2014) were divided patients into discharge categories: Early (≤ second postoperative day), Standard (postoperative day 3-7), Late (≥ postoperative day 7). We evaluated clinical and health care utilization differences for inpatient, outpatient, and emergency care at 90 days. We created multivariate logistic and Cox models to assess the association between discharge timing and complications, readmission, and patient and graft survival.
Results: 13.7% of recipients were discharged early (n=117), of which 73 were living donor kidney recipients (62.4% of group). Major complications at 30 days were correlated stepwise with discharge status (Early 8.5%, Standard 16.2%, Late 50%, p<0.0001). The readmission rate was 35.1%, and but was not significantly different based on discharge status (Early 27.4%, Standard 35.7%, Late 43.6%, p=0.083). ER utilization was similar in all groups (Early 39.2%, Standard 42.2%, Late 47.1%, p=0.69). Median outpatient clinic visits was 11 visits (range 1-23), and significantly lower in the early discharge group (p=0.006). On multivariate analysis, early discharge status was neither associated with hospital readmission (OR 0.68, 95% CI 0.44-1.04, p=0.078), nor was it associated with ER utilization (OR 0.89, 95% CI 0.60-1.33, p=0.58). Late discharge compared to normal was associated with significantly higher odds of ER utilization (OR 1.95, 95% CI 1.18-3.21, p=0.009). Graft and patient survival were similar based on discharge status on multivariate analysis (both, p=NS).
Conclusion: Day 2 discharge after kidney transplantation was not associated with significantly higher rates of complications, hospital readmissions, outpatient clinic or ER utilization at 90 days. Care process improvements to reduce initial length of stay after kidney transplant are safe and do not result in excess health care utilization.
CITATION INFORMATION: Mathur A, Katariya N, Welu A, Chang J, Heilman R, Singer A, Khamash H, Chakkera H, Hewitt W, Haakinson D, Maningo-Salinas M, Oakley E, Moss A, Reddy K. “Day 2 Discharge” After Kidney Transplantation: Complications, Health Care Utilization, and Long-Term Clinical Outcomes. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Mathur A, Katariya N, Welu A, Chang J, Heilman R, Singer A, Khamash H, Chakkera H, Hewitt W, Haakinson D, Maningo-Salinas M, Oakley E, Moss A, Reddy K. “Day 2 Discharge” After Kidney Transplantation: Complications, Health Care Utilization, and Long-Term Clinical Outcomes. [abstract]. Am J Transplant. 2016; 16 (suppl 3). http://atcmeetingabstracts.com/abstract/day-2-discharge-after-kidney-transplantation-complications-health-care-utilization-and-long-term-clinical-outcomes/. Accessed April 28, 2017.
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