Featured Research

from universities, journals, and other organizations

Early rehospitalization after kidney transplant caused by complexity of condition, not poor quality of care

Date:
October 31, 2013
Source:
Perelman School of Medicine at the University of Pennsylvania
Summary:
A study of over 750 kidney transplant patients over a five-year period has found that 90 percent of early rehospitalizations (within 30 days of surgery) were caused by complex medical factors related to the transplantation process. Only nine percent of rehospitalizations – which occurred among only three percent of the entire group of patients – were categorized as potentially preventable.

A study of over 750 kidney transplant patients over a five-year period conducted by researchers at the Perelman School of Medicine at the University of Pennsylvania has found that 90 percent of early rehospitalizations (within 30 days of surgery) were caused by complex medical factors related to the transplantation process. Only nine percent of rehospitalizations -- which occurred among only three percent of the entire group of patients -- were categorized as potentially preventable.

The study, published online this week in the American Journal of Transplantation, found that 237 patients (nearly one-third) were rehospitalized early following surgery, with a median of nine days to rehospitalization after discharge from kidney transplant. In most of these cases, the readmissions were unplanned and occurred as a result of common postsurgical complications. Deep vein thrombosis (blood clots), post-operative pain, organ rejection, fluid imbalances including volume overload (too much fluid in the blood) or volume depletion (decrease in volume of blood plasma, potentially leading to shock), and wound infections were key complicating factors leading to early rehospitalization.

"Nationally, high rates of early rehospitalization after kidney transplantation have been reported, but little information is available about what caused these events and whether they could be prevented," said lead study author Meera Nair Harhay, MD, MSCE, instructor of Medicine in the Renal, Electrolyte and Hypertension Division at Penn. "Early rehospitalization has also been examined by Medicare as a hospital quality of care indicator, with financial penalties for early rehospitalization after certain medical conditions. However, our findings indicate that transplant recipients are a particularly vulnerable group that often requires additional care after undergoing surgery and being exposed to new medications."

In the study, which is the first to use intensive chart review to assess preventability of early rehospitalization, two physicians independently examined the medical charts of the 237 readmitted transplant patients. Only 19 cases were found to be preventable readmissions by the reviewing physicians. Preventable causes of readmission identified by the study include 1) patients not having had an outpatient physician/nurse practitioner assessment before being admitted, 2) an alternative medical regimen not having been prescribed at discharge, 3) patients not having been compliant with their medication regimen, and 4) inadequate outpatient diagnostic or therapeutic procedures having been available.

The study also found that 30 percent of rehospitalized patients were originally discharged after their transplant on the weekend, versus 23 percent of patients who were not readmitted -a statistically significant finding highlighting the need for careful transitions of care when staffing is variable and more limited, such as occurs on the weekends. "If further multicenter studies confirm these findings, transplant centers should consider augmenting staffing and the oversight related to weekend discharges," said senior author Peter Reese MD, MSCE, assistant professor of Medicine and Epidemiology at Penn.

The study also revealed how long waiting times for transplantation increase the risk of post-transplant complications. For every year of additional waiting time prior to kidney transplantation, recipients were 10 percent more likely to experience early rehospitalization. Kidney transplant recipients who were rehospitalized within 30 days of transplant were 55 percent more likely to die within a six-year follow-up period than those who were not rehospitalized. "These findings indicate that early rehospitalization may be a strong signal of patient vulnerability, and such patients may benefit from more careful clinical monitoring post-transplant," said Harhay.


Story Source:

The above story is based on materials provided by Perelman School of Medicine at the University of Pennsylvania. Note: Materials may be edited for content and length.


Journal Reference:

  1. M. Harhay, E. Lin, A. Pai, M. O. Harhay, A. Huverserian, A. Mussell, P. Abt, M. Levine, R. Bloom, J. A. Shea, A. B. Troxel, P. P. Reese. Early Rehospitalization After Kidney Transplantation: Assessing Preventability and Prognosis. American Journal of Transplantation, 2013; DOI: 10.1111/ajt.12513

Cite This Page:

Perelman School of Medicine at the University of Pennsylvania. "Early rehospitalization after kidney transplant caused by complexity of condition, not poor quality of care." ScienceDaily. ScienceDaily, 31 October 2013. <www.sciencedaily.com/releases/2013/10/131031110514.htm>.
Perelman School of Medicine at the University of Pennsylvania. (2013, October 31). Early rehospitalization after kidney transplant caused by complexity of condition, not poor quality of care. ScienceDaily. Retrieved September 17, 2014 from www.sciencedaily.com/releases/2013/10/131031110514.htm
Perelman School of Medicine at the University of Pennsylvania. "Early rehospitalization after kidney transplant caused by complexity of condition, not poor quality of care." ScienceDaily. www.sciencedaily.com/releases/2013/10/131031110514.htm (accessed September 17, 2014).

Share This



More Health & Medicine News

Wednesday, September 17, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Obesity Rates Steady Even As Americans' Waistlines Expand

Obesity Rates Steady Even As Americans' Waistlines Expand

Newsy (Sep. 17, 2014) Researchers are puzzled as to why obesity rates remain relatively stable as average waistlines continue to expand. Video provided by Newsy
Powered by NewsLook.com
President To Send 3,000 Military Personnel To Fight Ebola

President To Send 3,000 Military Personnel To Fight Ebola

Newsy (Sep. 16, 2014) President Obama is expected to send 3,000 troops to West Africa as part of the effort to contain Ebola's spread. Video provided by Newsy
Powered by NewsLook.com
Obama Orders Military Response to Ebola

Obama Orders Military Response to Ebola

AP (Sep. 16, 2014) Calling the Ebola outbreak in West Africa a potential threat to global security, President Barack Obama is ordering 3,000 U.S. military personnel to the stricken region amid worries that the outbreak is spiraling out of control. (Sept. 16) Video provided by AP
Powered by NewsLook.com
UN: 20,000 Could Be Infected With Ebola by Year End

UN: 20,000 Could Be Infected With Ebola by Year End

AFP (Sep. 16, 2014) Nearly $1.0 billion dollars is needed to fight the Ebola outbreak raging in west Africa, the United Nations say, warning that 20,000 could be infected by year end. Duration: 00:40 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins