Prolonged rehospitalizations following renal transplantation: causes, risk factors, and outcomes.
BACKGROUND
Although some studies have described rehospitalization after transplantation, few have focused on risk factors and consequences of prolonged hospital stay. Our goal was to determine the causes, risk factors, and outcomes of prolonged rehospitalizations after renal transplantation.


METHODS
In this retrospective study, 574 randomly selected rehospitalization records of kidney transplant recipients were reviewed from 1994 to 2006. Admissions were divided into group 1, prolonged stay (length of stay >14 days, n=149), and group II, short stay (length of stay <or=14 days, n=425). Demographic data, cause of end-stage renal disease (ESRD), cause of readmission, ICU admission, time interval between transplantation and rehospitalization, costs, and in-patient mortality were compared between the two groups.


RESULTS
Mean (+/-SD) hospital stay was 10.6 +/- 9.8 days. Median hospital stay was 5 days for renal stones, 7 days for surgical complications, 8 days for malignancy, 9 days for infection, and 10 days for renal dysfunction. We found higher rates of ESRD due to diabetes in group I (28% vs. 15.4%; P=.006). Admissions due to infections (56.4% vs 42.4%; P=.003) or renal dysfunctions (55% vs 41.4%; P=.004) were the cause of higher proportions of total hospitalizations with prolonged stay. Prolonged stay also correlated with higher ICU admissions (8.8% vs 2.8%; P=.002) and mortality (6.7% vs 3.05%; P=.001). Mean total hospital cost for short versus prolonged hospitalizations were US$ 586 versus US$ 2750, respectively.


CONCLUSIONS
In this study, we found that prolonged hospital stays accounted for >62% of all hospital costs; however, they comprised only 26% of the patients. High-risk kidney transplant recipients for prolonged hospitalizations should be closely observed for infections and graft rejection.
Naderi
M
M
Nephrology/Urology Research Center (NURC), Baqiyatallah Medical Sciences University, Tehran, Iran.
Aslani
J
J
Hashemi
M
M
Assari
S
S
Amini
M
M
Pourfarziani
V
V
D000328:Adult; D003365:Costs and Cost Analysis; D003710:Demography; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007492:Iran; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome