title: Health care utilization and consequences of readmission in the first year after lung transplantation.
abstract: BACKGROUND
  Hospital readmissions are costly and have become a focus for quality improvement. We aimed to determine risk factors, rate, and outcomes of readmissions within the first year after lung transplantation and the potential impact on patient survival.
  
  
  METHODS
  A retrospective cohort study of all lung transplant recipients ≥18 years old who had undergone initial transplantation (2004-2013) at a single center was conducted. Logistic regression was used to identify independent predictors of readmission for patients who survived hospitalization. Cox regression was used to explore the relationship between readmission and long-term risk of death, while adjusting for potential confounders for patients who survived the first year.
  
  
  RESULTS
  During the study period, 412 patients met inclusion criteria for the readmission analysis. There were 276 patients (67%) readmitted within 1 year after lung transplantation for a total of 609 readmissions (average ± SD, 1.5 ± 2). Average length of readmission stay was 6 days ± 7, with 44% of readmissions lasting ≤3 days. Airway complications were found to be a significant risk factor for readmission (odds ratio, 4.18; 95% confidence interval, 1.78-9.54; p = 0.001). After adjustment, the overall risk of death was significantly higher with each readmission during the first year (hazard ratio, 1.22; 95% confidence interval, 1.13-1.31, p < 0.0001).
  
  
  CONCLUSIONS
  Most patients who survive the first post-operative year experience at least 1 readmission, with patients who experience airway complications at particular risk. Patients discharged to inpatient rehabilitation were less likely to be readmitted. The cumulative burden of multiple readmissions is associated with worse long-term survival.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Western Michigan University, Kalamazoo, Michigan. Electronic address: nathan.mollberg@gmail.com.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Mollberg
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: Eric
authors.initials: E
authors.lastname: Howell
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: David I
authors.initials: DI
authors.lastname: Vanderhoff
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: Aaron
authors.initials: A
authors.lastname: Cheng
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Mulligan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008171:Lung Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
keywords: lung transplant; morbidity; outcomes; readmission; survival