title: Early Postoperative Emergency Department Care of Abdominal Transplant Recipients.
abstract: BACKGROUND
  Research on posttransplant care has predominantly focused on predictors of readmission with little attention to emergency department (ED) visits. The goal of this study was to describe early postoperative ED care of transplant recipients.
  
  
  METHODS
  A secondary database analysis of adult patients who underwent abdominal organ transplantation between January 1, 2008, and December 31, 2013, and sought ED care within 1 year after transplantation was conducted. Survival was compared using the Kaplan-Meier method with log-rank test. Cox proportional hazards regression analysis was performed to adjust for pertinent covariates
  
  
  RESULTS
  A total of 1900 abdominal organ transplants were performed during the study period. Of these, 37% (N = 711) transplant recipients sought care in the ED (1343 total visits) with 1.89 mean ED visits per recipient. Of recipients seen in the ED, 58% received a kidney transplant and 28% received a liver transplant, with 45% of recipients presenting within the first 60 postoperative days. The most common chief complaints were gastroenterological (17%) and abnormal laboratory values or vital signs (17%). In total, 74% of recipients were readmitted and 50% of admitted patients were discharged in less than 24 hours. Transplant recipients with ED visits had lower 3-year graft (81% vs 87%; P < 0.001) and patient (89% vs 93%; P = 0.002) survival.
  
  
  CONCLUSIONS
  Transplant recipients have a high frequency of ED visits in the first posttransplantation year and high rates of subsequent hospital admission. Further investigation is needed to understand what drives recipient presentation to the ED and create care models that achieve the best outcomes.
authors.affiliation: 1 Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL. 2 Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL. 3 Department of Emergency Medicine, Northwestern Memorial Hospital, Chicago, IL.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: McElroy
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Schmidt
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Richards
authors.forename: Brittany
authors.initials: B
authors.lastname: Lapin
authors.forename: Michael M
authors.initials: MM
authors.lastname: Abecassis
authors.forename: Jane L
authors.initials: JL
authors.lastname: Holl
authors.forename: James
authors.initials: J
authors.lastname: Adams
authors.forename: Daniela P
authors.initials: DP
authors.lastname: Ladner
mesh_terms: D000328:Adult; D000368:Aged; D002641:Chicago; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000401:mortality; D010359:Patient Readmission; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome