Emergency Department Utilization Among Kidney Transplant Recipients in the United States.
Emory University, Atlanta, GA
Meeting: 2017 American Transplant Congress
Abstract number: 240
Keywords: Kidney transplantation, Resource utilization, Surgical complications
Session Information
Session Name: Concurrent Session: Kidney Clinical Psychosocial
Session Type: Concurrent Session
Date: Monday, May 1, 2017
Session Time: 2:30pm-4:00pm
Presentation Time: 2:30pm-2:42pm
Location: E354b
Background:
Single center studies suggest that kidney transplant (KTx) recipients have a high rate of emergency department (ED) utilization, and ED visits are associated with graft failure and patient mortality. However, ED utilization among a national KTx patient population has not been examined.
Methods:
We examined a cohort of 132,725 incident adult kidney transplant patients in the United States Renal Data System from 2005-2013. ED utilization, hospital admission, and diagnoses were obtained from the USRDS and Medicare Physician/Supplier and Inpatient databases for Medicare Part A/B claims.
Results:
Nearly half (46.1%) of national KTx recipients had at least one ED visit within the first year of diagnosis (1.61 ED visits/patient year), and 41% of ED visits resulted in hospital admission. Factors associated with higher ED utilization included female sex, public insurance medical comorbidities, longer dialysis vintage, and DCD donors. Preemptive transplant, living donors, and private insurance were associated with lower ED utilization. Graft complications, sepsis, and urinary tract infections were the most common indications for hospital admission (27.7%). ED utilization was associated with lower rates of graft survival (83.3 vs. 60.9%) and patient survival (83.5 vs. 61.3%)(both p<0.0001).
| 5 Years Post-Kidney Transplant
Study Period (2005-2013) N=132,725 |
1st Year Post-Transplant
N=132,725 |
ESRD on Dialysis
Study Period N=769,228 |
|
| Patients with ED visits | 85,060 (64.1%) | 61,125 (46.1%) | 535,345 (69.6%) |
| Total Number of ED visits | 625,325 | 197,503 | 4,562,939 |
| Average ED Visits per Person-Year | 1.15 | 1.61 | 2.68 |
| Number of Deaths | 16,931 (12.7%) | 4,478 (3.4%) | 345,937 (45.0%) |
| Hospital Admissions from the ED (% of ED visits) | 256,687 (41.0%) | 78,408 (39.7%) | 2,108,915 (46%) |
Discussion:
ED utilization for KTx recipients is nearly three-fold higher than the national average for ED utilization (1.15 vs. 0.4), but less than half the rate for ESRD patients on dialysis (2.68). When compared with ESRD patients, KTx recipients have a lower rates of ED utilization, hospital admission, and mortality. ED utilization was associated with worse graft and patient survival, and many returns to acute care were due to preventable pathologies. Strategies addressing earlier access to transplantation and infection control are areas with potential for improvement and savings.
CITATION INFORMATION: Lovasik B, Zhang R, Schrager J, Pastan S, Adams A, Patzer R. Emergency Department Utilization Among Kidney Transplant Recipients in the United States. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Lovasik B, Zhang R, Schrager J, Pastan S, Adams A, Patzer R. Emergency Department Utilization Among Kidney Transplant Recipients in the United States. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/emergency-department-utilization-among-kidney-transplant-recipients-in-the-united-states/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress