title: Timing and Frequency of Unplanned Readmissions After Lung Transplantation Impact Long-Term Survival.
abstract: BACKGROUND
  Adverse events that require hospital readmission frequently occur long after lung transplantation (LT) that has been successfully performed. We sought to identify the causes and rate of unplanned readmissions after LT and to determine whether unplanned readmissions have a significant impact on post-LT survival.
  
  
  METHODS
  We retrospectively reviewed the outcomes in 174 LT recipients who underwent LT at our center from June 2005 to May 2014. The median follow-up period was 38 months (range, 17 to 72 months).
  
  
  RESULTS
  One hundred sixty (92%) of the 174 recipients were readmitted 854 times (5.3 times per patient). The median time to first readmission was 71 days (interquartile range [IQR], 28 to 240 days), and the median hospital length of stay at readmission was 3 days (IQR, 2 to 6 days). Freedom from first readmission was observed for 65% of patients at 1 month, 48% at 3 months, 43% at 6 months, and 26% at 12 months. Gender, lung allocation score, body surface area, year of transplantation, air leak longer than 5 days after operation, and allograft function were risk factors for readmission. The causes of readmission included infections (33%), respiratory adverse events (18%), rejection (15%), gastrointestinal events (15%), renal dysfunction (5%), and cardiac events (4%). Patients who died were found to have had early readmissions (p = 0.04) and more frequent readmissions (p = 0.001).
  
  
  CONCLUSIONS
  The first year after LT remains a high-risk period for unplanned readmissions regardless of pretransplantation diagnosis. Readmissions soon after discharge at index hospitalization and multiple readmissions are associated with an increased risk of mortality.
authors.affiliation: Department of Surgery, Section of Cardiothoracic Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Entela
authors.initials: E
authors.lastname: Lushaj
authors.affiliation: Department of Surgery, Section of Cardiothoracic Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Walker
authors.initials: W
authors.lastname: Julliard
authors.affiliation: Department of Surgery, Section of Cardiothoracic Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Shahab
authors.initials: S
authors.lastname: Akhter
authors.affiliation: Department of Surgery, Section of Cardiothoracic Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Glen
authors.initials: G
authors.lastname: Leverson
authors.affiliation: Department of Surgery, Section of Cardiothoracic Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: James
authors.initials: J
authors.lastname: Maloney
authors.affiliation: Department of Medicine, Section of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Cornwell
authors.affiliation: Department of Medicine, Section of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Keith C
authors.initials: KC
authors.lastname: Meyer
authors.affiliation: Department of Surgery, Section of Cardiothoracic Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin. Electronic address: oliveira@surgery.wisc.edu.
authors.forename: Nilto
authors.initials: N
authors.lastname: DeOliveira
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008171:Lung Diseases / Q000601:surgery; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014922:Wisconsin / Q000453:epidemiology