Date: Tuesday, June 5, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Introduction & Objective: Kidney transplant recipients have higher rates of prolonged hospitalization and readmission rates. We aimed to identify modifiable predictors of 30-day readmission and to develop standardized follow-up based on our findings.
Methods: Data were retrospectively collected for 343 adult kidney-only transplant recipients from Jan 2015 to Oct 2017. 30-day readmission was defined as readmission to any medical facility within 30 days of discharge from index admission. Preventable readmissions, defined as either due to modifiable risk factors or not requiring inpatient level of care, were identified by consensus review. Data were analyzed using the chi-squared, 2-tailed t-test, or Mann-Whitney U test.
Results: Total 30-day readmission rate was 22.4%. Patients were 18 to 76 yrs, 60.6% male and 68.8% white/24.2% black /7% other. Pre-transplant diabetes was prevalent in 25.9%. The readmission rate among diabetics was 31.5% vs 19.3% (p=0.018). 59 patients (20.5%) had prior organ transplant and a higher proportion of these patients were readmitted (32.7% vs 20.5% p=0.046). There was no correlation between living vs. deceased donor recipients, DBD vs DCD or KDPI > 85 for deceased donors and readmission rate. Median EBL was higher in patients who were readmitted (250cc vs 200cc [p=0.012]). Readmitted patients had a longer index median LOS (7 days vs 5 [p<0.0001]). 33.8% of the 77 patients readmitted presented back within 5 days and 50.6% within 10 days. 35.1% of readmissions were deemed preventable. Approximately 1/3 of these were reviewed as appropriate for outpatient or observation level of care. The largest proportion of preventable readmissions was in patients presenting with metabolic derangements and/or chronic anemia. Standardized follow-up was implemented accordingly and as of Sept 1st consists of verbal handoff to the outpatient team, POD#1 & #5 phone calls to the patient and scheduling of the 1st clinic visit within 5 days. 13 patients have since been transplanted with median LOS of 4 days and 1 readmission (7.7%).
Conclusions: Efforts to decrease readmissions led to a change in post-discharge care for kidney recipients at our institution. The sample size is currently too small to determine statistical significance (13 patients, 1 readmitted). Nevertheless, the results are encouraging and will be closely followed prospectively.
CITATION INFORMATION: Crane A., Eltemamy M., Coy T., Babbar P., Sun A., Jacobsen D., Ponziano M., Poggio E., Wee A., Fatica R., Krishnamurthi V. Implementation of Intensive Standardized Follow-Up in Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Crane A, Eltemamy M, Coy T, Babbar P, Sun A, Jacobsen D, Ponziano M, Poggio E, Wee A, Fatica R, Krishnamurthi V. Implementation of Intensive Standardized Follow-Up in Kidney Transplant Recipients [abstract]. https://atcmeetingabstracts.com/abstract/implementation-of-intensive-standardized-follow-up-in-kidney-transplant-recipients/. Accessed February 23, 2019.
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