Predictors and outcomes of unplanned early rehospitalization in the first year following lung transplantation.
Unplanned early rehospitalization (UER), defined as an unscheduled admission within 30 days of a hospital discharge, is associated with graft loss and recipient mortality in some solid organ transplants but has not been investigated in lung transplant. In this retrospective study, we collected socio-demographic and clinical factors to determine predictors and outcomes of UER in the first year following lung transplantation. There were 193 patients who underwent lung transplantation and survived to discharge during the 7.9-year study period. There were 116 (60.1%) patients with at least one UER. Infections (32.8%) and post-surgical complications (11.8%) were the most common reasons for UER. On multivariate analysis, the strongest predictor of having an UER was discharge to a long-term acute care facility (odds ratio: 3.01, 95% confidence interval [CI] 1.46-6.20; P=.003). Patients with any UER in the first year following transplantation had worse adjusted survival (hazard ratio: 1.89, 95% CI 1.02-3.50; P=.04). It is unclear, however, to what extent UERs reflect preventable outcomes. Further large-scale, prospective research is needed to identify the extent to which certain types of UER are modifiable and to define patients at high-risk for preventable UER.
Division of Pulmonary and Critical Care Division, Brigham and Women's Hospital, Boston, MA, USA.
Andrew M
AM
Courtwright
Social Work, Care Coordination, Brigham and Women's Hospital, Boston, MA, USA.
Stacey
S
Salomon
Division of Pulmonary and Critical Care Division, Brigham and Women's Hospital, Boston, MA, USA.
Anne
A
Fuhlbrigge
Division of Pulmonary and Critical Care Division, Brigham and Women's Hospital, Boston, MA, USA.
Miguel
M
Divo
Division of Pulmonary and Critical Care Division, Brigham and Women's Hospital, Boston, MA, USA.
Ivan O
IO
Rosas
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Phillip C
PC
Camp
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Hari H
HH
Mallidi
Division of Pulmonary and Critical Care Division, Brigham and Women's Hospital, Boston, MA, USA.
Patrick
P
Burkett
Division of Pulmonary and Critical Care Division, Brigham and Women's Hospital, Boston, MA, USA.
Souheil
S
El-Chemaly
Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.
David J
DJ
Wolfe
Division of Pulmonary and Critical Care Division, Brigham and Women's Hospital, Boston, MA, USA. hjgoldberg@partners.org.
Hilary J
HJ
Goldberg
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016040:Lung Transplantation; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000639:trends*; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
long-term acute care; lung transplant; readmission; rehospitalization; survival