title: Emergency Department Visits after Kidney Transplantation.
abstract: OBJECTIVE
  In 2011, there were approximately 131 million visits to an emergency department in the United States. Emergency department visits have increased over time, far outpacing growth of the general population. There is a paucity of data evaluating emergency department visits among kidney transplant recipients. We sought to evaluate the incidence and risk factors for emergency department visits after initial hospital discharge after transplantation in the United States.
  
  
  METHODS
  We identified 10,533 kidney transplant recipients from California, New York, and Florida between 2009 and 2012 using the State Inpatient and Emergency Department Databases included in the Healthcare Cost and Utilization Project. We used multivariable Poisson and Cox proportional hazard models to evaluate adjusted incidence rates and time to emergency department visits after transplantation.
  
  
  RESULTS
  There were 17,575 emergency department visits over 13,845 follow-up years (overall rate =126.9/100 patient-years; 95% confidence interval, 125.1 to 128.8). The cumulative incidences of emergency department visits at 1, 12, and 24 months were 12%, 40%, and 57%, respectively, with median time =19 months; 48% of emergency department visits led to hospital admission. Risk factors for higher emergency department rates included younger age, women, black and Hispanic race/ethnicity, public insurance, depression, diabetes, peripheral vascular disease, and emergency department use before transplant. There was wide variation in emergency department visits by individual transplant center (10th percentile =70.0/100 patient-years; median =124.6/100 patient-years; and 90th percentile =187.4/100 patient-years).
  
  
  CONCLUSIONS
  The majority of kidney transplant recipients will visit an emergency department in the first 2 years post-transplantation, with significant variation by patient characteristics and individual centers. As such, coordination of care through the emergency department is a critical component of post-transplant management, and specific acumen of transplant-related care is needed among emergency department providers. Additional research assessing best processes of care for post-transplant management and health care expenditures and outcomes associated with emergency department visits for transplant recipients are warranted.
authors.affiliation: Departments of Quantitative Health Sciences and scholdj@ccf.org.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Schold
authors.affiliation: Glickman Urological and Kidney Institute, and.
authors.forename: Nissreen
authors.initials: N
authors.lastname: Elfadawy
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Buccini
authors.affiliation: Glickman Urological and Kidney Institute, and.
authors.forename: David A
authors.initials: DA
authors.lastname: Goldfarb
authors.affiliation: Glickman Urological and Kidney Institute, and.
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Flechner
authors.affiliation: Emergency Medicine.
authors.forename: Michael
authors.initials: M
authors.lastname: P Phelan
authors.affiliation: Glickman Urological and Kidney Institute, and.
authors.forename: Emilio D
authors.initials: ED
authors.lastname: Poggio
mesh_terms: D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D055815:Young Adult
keywords: Emergency Service, Hospital; Follow-Up Studies; Health Care Costs; Humans; Transplant Recipients; diabetes mellitus; ethnicity; hospitalization; kidney transplantation; transplant outcomes