Introduction: The Affordable Care Act, added to the Social Security Act, established the Hospital Readmission Reduction Program which will penalize hospitals with excessive 30-day readmissions effective for discharges beginning October 1, 2012. This has been very controversial as the literature suggests that with certain conditions, such as congestive heart failure, patient survival may be improved with early readmission. A major deficiency of such a policy is that an established baseline readmission rate with causality has not been defined in the literature in each medical and surgical subspecialty and for specific diagnoses and procedures. Thus, we report on the rate and causality of all 30-day readmissions after renal transplantation at our institution in an effort to provide meaningful data with which to establish readmission reduction goals.

Methods: We retrospectively reviewed all 30-day readmissions following renal transplantation as the index diagnosis from January 2009 through December 2011. During this time period a total of 421 adult renal transplants were performed. Thirty-day readmissions were identified and causality categorized as follows: Cardiovascular (CV), Fluid/Electrolyte (FE), Infectious (I), Surgical (S), Graft Dysfunction (ARF), Gastrointestinal (GI), DVT/PE (D), and Other (O).

Results: A total of 421 adult renal transplants were performed during this time period. The overall 30-day readmission rate was 28.2 % (n=119). Specific reasons for readmission included: CV (6.7%), FE (28.6%), I (16%), S (12.6%), ARF (5.9%), GI (13.4%), D (5%), O (11.8%). Overall one-year patient and graft survival for this period was 97% and 96%, respectively, from 1/1/2009 – 6/30/2011. According to the Scientific Registry of Transplant Recipients (SRTR), one year patient and graft survival met or exceeded the expected projections.

Conclusion: Although a recently published report detailed risk factors for readmission among the Medicare population, we present here single center data in a broad patient population (including Medicare, private insurance, and living donor recipients) regarding rates and causality for 30-day readmission following an index renal transplant. What ultimately must be done in order to create educated readmission reduction goals is to define whether 30-day readmission indeed has a deleterious effect on the patient and to determine if alterations of modifiable risk factors can reduce unnecessary readmissions.

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