Kidney transplant patients are at high risk of rehospitalization after their initial procedure, and more than two-thirds are readmitted to the hospital within 30 days, according to a new study.
Using national data that spanned a six-year period, researchers at the Johns Hopkins University School of Medicine found that three in 10 patients receiving a kidney transplant require readmission to the hospital within 30 days of discharge following surgery.
The new findings are significant as new initiatives, such as those in the Patient Protection and Affordable Care Act, aim to reign in unnecessary and avoidable readmissions that cost the U.S. healthcare system an estimated $25 billion a year. The Centers for Medicare and Medicaid Services has begun the process of decreasing reimbursements to hospitals with high readmission rates, using readmissions as one measure of hospital quality.
The report, published online in the American Journal of Transplantation, suggests that more needs to be done to manage patients outside the hospital to keep them from costly and potentially preventable return hospital visits. More specifically, the report says better systems for outpatient management could be developed and certain patients could use more intense monitoring.
The Johns Hopkins researchers examined data provided by the Organ Procurement and Transplantation Network, Medicare, and the United States Renal Data System from more than 32,000 patients who received kidney transplants in U.S. hospitals between Jan. 1, 2000 and Dec. 31, 2005. While 31 percent of transplant recipients required readmission within 30 days, the percent of patients returning varied by hospital, from 18 percent to nearly 50 percent.
Age, race, body mass index, diabetes, heart disease and several other factors were associated with early hospital readmission. African-Americans had an 11 percent increased risk of readmission, and obese patients had a 15 percent increased risk, while diabetic women were at a 29 percent increased risk. Interestingly, patients who stayed in the hospital for five or more days at the time of their transplants were more likely to be readmitted within 30 days. This may be a sign that the more complex cases early on appear to remain complex and are more likely to require additional care, according to the report.
Patients who are readmitted back to the hospital are not only returning for complications related to their new organs — such as infections or problems related to immunosuppressant drugs they need to keep from rejecting the new organ — but often for problems related to other illnesses they had before they received their transplants. While medical teams are charged with making sure that a transplant candidate’s condition, such as heart disease or diabetes, is stable before a transplant takes place, those conditions can still cause complications after surgery. The entire medical team needs to ensure that patients with co-morbidities are very closely followed.
“Kidney transplant is complex and the management of the first 30 days is complex,” study leader Dr. Dorry L. Segev, an associate professor of surgery at the Johns Hopkins University School of Medicine, said in a press release. “We will never get the readmission rate down to zero, but it’s highly likely we can get it down from nearly one-third.”
Segev says he hopes that transplant centers with higher rates of readmission can learn lessons from centers with lower rates. They may find that those centers schedule more frequent outpatient visits, offer more opportunities to communicate with clinicians via email or the telephone, or are better at coordinating services such as blood work that may be needed after discharge so that critical post-transplant medication adjustments can be made quickly before a readmission is required.