Causes, Preventability, and Cost of Unplanned Rehospitalizations Within 30 Days of Discharge After Lung Transplantation

被引:32
作者
Courtwright, Andrew M. [1 ]
Zaleski, Derek [2 ]
Gardo, Lisa [1 ]
Ahya, Vivek N. [1 ]
Christie, Jason D. [1 ]
Crespo, Maria [1 ,3 ]
Hadjiliadis, Denis [1 ]
Lee, James [1 ]
Molina, Maria
Patel, Namrata [1 ]
Porteous, Mary [1 ]
Cantu, Edward E. [3 ]
Bermudez, Christian [3 ]
Diamond, Joshua M. [1 ]
机构
[1] Univ Penn, Pulm & Crit Care Med, Philadelphia, PA 19104 USA
[2] Good Shepard Penn Partners, Philadelphia, PA USA
[3] Univ Penn, Cardiothorac Surg, Philadelphia, PA 19104 USA
基金
美国国家卫生研究院;
关键词
INTENSIVE-CARE-UNIT; QUALITY-OF-LIFE; HOSPITAL READMISSION; KIDNEY-TRANSPLANTATION; FRAILTY; PREDICTORS; SURVIVAL; DISABILITY; MORTALITY; IMPACT;
D O I
10.1097/TP.0000000000002101
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Unplanned rehospitalizations (UR) within 30 days of discharge are common after lung transplantation. It is unknown whether UR represents preventable gaps in care or necessary interventions for complex patients. The objective of this study was to assess the incidence, causes, risk factors, and preventability of UR after initial discharge after lung transplantation. Methods. This was a single-center prospective cohort study. Subjects completed a modified short physical performance battery to assess frailty at listing and at initial hospital discharge after transplantation and the State-Trait Anxiety Inventory at discharge. For each UR, a study staff member and the patient's admitting or attending clinician used an ordinal scale (0, not; 1, possibly; 2, definitely preventable) to rate readmission preventability. A total sum score of 2 or higher defined a preventable UR. Results. Of the 90 enrolled patients, 30 (33.3%) had an UR. The single most common reasons were infection (7 [23.3%]) and atrial tachyarrhythmia (5 [16.7%]). Among the 30 URs, 9 (30.0%) were deemed preventable. Unplanned rehospitalization that happened before day 30 were more likely to be considered preventable than those between days 30 and 90 (30.0% versus 6.2%, P = 0.04). Discharge frailty, defined as short physical performance battery less than 6, was the only variable associated with UR onmultivariable analysis (odds ratio, 3.4; 95% confidence interval, 1.1-11.8; P = 0.04). Conclusions. Although clinicians do not rate the majority of UR after lung transplant as preventable, discharge frailty is associated with UR. Further research should identify whether modification of discharge frailty can reduce UR.
引用
收藏
页码:838 / 844
页数:7
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