Readmitted to Hospital Within 30 Days

Photo: Patient

Extremely high risk of return
requires focus on outpatient

The findings suggest more needs to be done to manage patients outside the hospital to keep them from costly and potentially preventable return visits. Readmissions are said to cost the U.S. health care system 25 billion Dollars a year. The Centers for Medicare and Medicaid Services has begun the process of decreasing reimbursements to hospitals with high readmission rates, using readmissions as a surrogate measure of hospital quality.

"We need to be aware that kidney transplant recipients have an extremely high risk of returning to the hospital in the first 30 days after discharge, and that readmissions may very well be prevented by putting in place better systems for outpatient management," says study leader Doctor Dorry L. Segev. "Some patients just need more intense monitoring."

Segev and his colleagues examined data provided by the Organ Procurement and Transplantation Network, Medicare, and the United States Renal Data System from more than 32,000 patients who received kidney transplants in U.S. hospitals between January 1, 2000 and December 31, 2005. While 31 percent of transplant recipients required readmission within 30 days, the percent of patients returning varied by hospital, from 18 percent to nearly 50 percent, a variation that could not be accounted for by conventional issues of center volume or demographics.

Age, race, body mass index, diabetes, heart disease and several other factors were associated with early hospital readmission. African-Americans had an 11 percent increased risk of readmission, and obese patients had a 15 percent increased risk, while diabetic women were at a 29 percent increased risk. Interestingly, those patients who stayed in the hospital for five or more days at the time of their transplants were more likely to be readmitted within 30 days. Segev says this may be a sign that the more complex cases early on appear to remain complex and more likely to require additional care.

Patients who bounce back to the hospital are not returning only for complications related to their new organs — such as infections or problems related to immunosuppressant drugs they need to keep from rejecting the new organ — but often for problems related to other illnesses they had before they received their transplants. Segev says even though medical teams make sure that the heart disease or diabetes a transplant candidate may have is stable before a transplant takes place, those conditions can still cause complications after surgery. The entire medical team needs to be sure people with co-morbidities are very closely followed, he says.

"Kidney transplant is complex and the management of the first 30 days is complex," he adds. "We will never get the readmission rate down to zero, but it is highly likely we can get it down from nearly one-third."; Source: Johns Hopkins Medicine