Pattern and Predictors of Hospital Readmission During the First Year After Lung Transplantation.
Hospital readmission after lung transplantation negatively affects quality of life and resource utilization. A secondary analysis of data collected prospectively was conducted to identify the pattern of (incidence, count, cumulative duration), reasons for and predictors of readmission for 201 lung transplant recipients (LTRs) assessed at 2, 6, and 12 mo after discharge. The majority of LTRs (83.6%) were readmitted, and 64.2% had multiple readmissions. The median cumulative readmission duration was 19 days. The main reasons for readmission were other than infection or rejection (55.5%), infection only (25.4%), rejection only (9.9%), and infection and rejection (0.7%). LTRs who required reintubation (odds ratio [OR] 1.92; p = 0.008) or were discharged to care facilities (OR 2.78; p = 0.008) were at higher risk for readmission, with a 95.7% cumulative incidence of readmission at 12 mo. Thirty-day readmission (40.8%) was not significantly predicted by baseline characteristics. Predictors of higher readmission count were lower capacity to engage in self-care (incidence rate ratio [IRR] 0.99; p = 0.03) and discharge to care facilities (IRR 1.45; p = 0.01). Predictors of longer cumulative readmission duration were older age (arithmetic mean ratio [AMR] 1.02; p = 0.009), return to the intensive care unit (AMR 2.00; p = 0.01) and lower capacity to engage in self-care (AMR 0.99; p = 0.03). Identifying LTRs at risk may assist in optimizing predischarge care, discharge planning and long-term follow-up.
School of Nursing, University of Pittsburgh, Pittsburgh, PA.
M
http://orcid.org/0000-0003-4657-0247
M
Alrawashdeh
Cardiothoracic Transplantation Program, UPMC, Pittsburgh, PA.
R
R
Zomak
School of Medicine, University of Pittsburgh, Pittsburgh, PA.
M A
http://orcid.org/0000-0002-4666-1870
MA
Dew
School of Nursing, University of Pittsburgh, Pittsburgh, PA.
S
S
Sereika
School of Nursing, University of North Carolina, Chapel Hill, NC.
M K
MK
Song
School of Medicine, University of Pittsburgh, Pittsburgh, PA.
J M
JM
Pilewski
School of Nursing, University of Pittsburgh, Pittsburgh, PA.
A
A
DeVito Dabbs
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D012648:Self Care; D013997:Time Factors
allied health/nursing; clinical research/practice; complication; health services and outcomes research; hospital discharge; hospital readmission; lung disease; lung transplantation/pulmonology; patient characteristics
Biometrics. 1986 Mar;42(1):121-30
3719049
J Gen Intern Med. 2012 Nov;27(11):1467-74
22692634
Surgery. 2014 Oct;156(4):871-8
25239337
Eur J Gastroenterol Hepatol. 2015 May;27(5):600-6
25822868
Phys Ther. 2005 Mar;85(3):257-68
15733050
Liver Transpl. 2012 Sep;18(9):1007-8
22847799
J Am Geriatr Soc. 2015 Mar;63(3):548-52
25803786
Clin Trials. 2013;10(6):896-906
23867222
Am J Transplant. 2014 Jan;14 Suppl 1:139-65
24373171
Aust J Prim Health. 2013;19(3):198-206
22950823
J Am Geriatr Soc. 2013 Jul;61(7):1175-81
23730901
Semin Respir Crit Care Med. 2006 Oct;27(5):508-20
17072799
Am J Epidemiol. 2009 Jul 15;170(2):244-56
19494242
Eur J Cardiothorac Surg. 2011 May;39(5):726-31
21084198
Med Care. 1999 Jan;37(1):5-14
10413387
Asian J Psychiatr. 2014 Feb;7(1):34-7
24524707
Patient Educ Couns. 2010 Mar;78(3):297-315
20202778
Semin Respir Crit Care Med. 2006 Oct;27(5):544-51
17072802
Clin Transplant. 2009 Aug-Sep;23(4):537-45
19473201
Prev Med. 2014 Oct;67:330-4
25088410
Transpl Infect Dis. 2014 Jun;16(3):347-58
24750282
Health Educ Monogr. 1978 Spring;6(2):107-17
357347
Health Educ Monogr. 1978 Spring;6(2):160-70
689890
Cerebrovasc Dis. 2006;22(1):21-6
16567933
J Clin Epidemiol. 2006 Oct;59(10):1102-9
16980151
Am J Respir Crit Care Med. 1995 Jul;152(1):137-41
7599812
Epidemiology. 2010 Sep;21(5):626-30
20588183
Transplantation. 2013 Aug 15;96(3):316-23
23715048
Proc Am Thorac Soc. 2009 Jan 15;6(1):101-7
19131535
Am J Transplant. 2013 Apr;13(4):839-50
23432992
Policy Polit Nurs Pract. 2010 Nov;11(4):309-16
21531966
J Vasc Surg. 2014 May;59(5):1349-55
24368042
J Heart Lung Transplant. 1999 Jun;18(6):549-62
10395353
J Heart Lung Transplant. 2009 Oct;28(10):1007-22
19782283
Transplant Proc. 2007 Sep;39(7):2409-12
17889204
Clin Transplant. 2001;15 Suppl 4:23-8
11778784
Risk Manag Healthc Policy. 2014 May 28;7:105-12
24971039
JAMA. 2011 Oct 19;306(15):1688-98
22009101
Patient Educ Couns. 2002 Oct -Nov;48(2):177-87
12401421
Ann Thorac Surg. 2015 Jan;99(1):251-7
25440281
Curr Med Res Opin. 2013 Oct;29(10):1315-28
23777312
Exp Clin Transplant. 2009 Sep;7(3):192-6
19715532
Clin Transplant. 2013 Jan-Feb;27(1):113-20
23004565
Dtsch Arztebl Int. 2014 Feb 14;111(7):107-16
24622680
Int J Qual Health Care. 2014 Aug;26(4):358-65
24744082
J Heart Lung Transplant. 2010 Mar;29(3):240-6
19932034
Ann Thorac Surg. 2012 Jul;94(1):185-92
22325467
Am J Transplant. 2016 Jul;16(7):2172-80
26729617
JAMA. 2011 Feb 2;305(5):504-5
21285430
Transplantation. 2011 Jun 15;91(11):1297-303
21572382
Korean J Intern Med. 2015 Jul;30(4):506-14
26161017
Ann Intern Med. 1995 Mar 15;122(6):415-21
7856989
Chest. 2013 Mar;143(3):744-50
23188377
Transplant Proc. 2009 May;41(4):1339-44
19460554
Gastroenterol Hepatol (N Y). 2011 Sep;7(9):585-90
22298997
J Heart Lung Transplant. 2011 Jan;30(1):54-8
20888787
Ann Intern Med. 2015 Jun 2;162(11):741-9
26030632
BMC Health Serv Res. 2010 Nov 17;10:311
21080970
J Healthc Manag. 2010 Jul-Aug;55(4):252-64
20812526
JAMA. 2013 Jan 23;309(4):345-6
23340632
Chest. 2014 Sep;146(3):590-9
24832379
Eur J Cardiothorac Surg. 2012 Jan;41(1):193-9
21665487
Biol Blood Marrow Transplant. 2012 Jun;18(6):874-80
22040844
Stat Med. 1998 Jun 15;17(11):1261-91
9670414
JAMA. 2011 Feb 16;305(7):675-81
21325183
Adv NPs PAs. 2013 Feb;4(2):12
23437611