title: Early Hospital Readmission After Simultaneous Pancreas-Kidney Transplantation: Patient and Center-Level Factors.
abstract: Early hospital readmission is associated with increased morbidity, mortality, and cost. Following simultaneous pancreas-kidney transplantation, rates of readmission and risk factors for readmission are unknown. We used United States Renal Data System data to study 3643 adult primary first-time simultaneous pancreas-kidney recipients from December 1, 1999 to October 31, 2011. Early hospital readmission was any hospitalization within 30 days of discharge. Modified Poisson regression was used to determine the association between readmission and patient-level factors. Empirical Bayes statistics were used to determine the variation attributable to center-level factors. The incidence of readmission was 55.5%. Each decade increase in age was associated with an 11% lower risk of readmission to age 40, beyond which there was no association. Donor African-American race was associated with a 13% higher risk of readmission. Each day increase in length of stay was associated with a 2% higher risk of readmission until 14 days, beyond which each day increase was associated with a 1% reduction in the risk of readmission. Center-level factors were not associated with readmission. The high incidence of early hospital readmission following simultaneous pancreas-kidney transplant may reflect clinical complexity rather than poor quality of care.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: E A
authors.initials: EA
authors.lastname: King
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
authors.forename: L M
authors.initials: LM
authors.lastname: Kucirka
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
authors.forename: M A
authors.initials: MA
authors.lastname: McAdams-DeMarco
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
authors.forename: A B
authors.initials: AB
authors.lastname: Massie
authors.affiliation: Department of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: F
authors.initials: F
authors.lastname: Al Ammary
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: R
authors.initials: R
authors.lastname: Ahmed
authors.affiliation: Department of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: M E
authors.initials: ME
authors.lastname: Grams
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000328:Adult; D000367:Age Factors; D001499:Bayes Theorem; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology* / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D016035:Pancreas Transplantation / Q000009:adverse effects*; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors
keywords: clinical decision-making; clinical research/practice; health services and outcomes research; hospital readmission; pancreas/simultaneous pancreas-kidney transplantation; quality of care/care delivery