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Hospital readmission following pediatric heart transplantation
Author(s) -
Mahle William T.,
Mason Kristen L.,
Dipchand Anne I.,
Richmond Marc,
Feingold Brian,
Canter Charles E.,
Hsu Daphne T.,
Singh Tajinder P.,
Shaddy Robert E.,
Armstrong Brian D.,
Zeevi Adriana,
Iklé David N.,
Diop Helena,
Odim Jonah,
Webber Steven A.
Publication year - 2019
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13561
Subject(s) - medicine , hospital readmission , heart transplantation , incidence (geometry) , transplantation , hazard ratio , emergency medicine , proportional hazards model , heart transplants , intensive care medicine , pediatrics , confidence interval , physics , optics
The frequency, indications, and outcomes for readmission following pediatric heart transplantation are poorly characterized. A better understanding of this phenomenon will help guide strategies to address the causes of readmission. Data from the Clinical Trials in Organ Transplantation for Children (CTOTC‐04) multi‐institutional collaborative study were utilized to determine incidence of, and risk factors for, hospital readmission within 30 days and 1 year from initial hospital discharge. Among 240 transplants at 8 centers, 227 subjects were discharged and had follow‐up. 129 subjects (56.8%) were readmitted within one year; 71 had two or more readmissions. The 30‐day and 1‐year freedom from readmission were 70.5% (CI: 64.1%, 76.0%) and 42.2% (CI: 35.7%, 48.7%), respectively. The most common indications for readmissions were infection followed by rejection and fever without confirmed infection, accounting for 25.0%, 10.6%, and 6.2% of readmissions, respectively. Factors independently associated with increased risk of first readmission within 1 year (Cox proportional hazard model) were as follows: transplant in infancy ( P = .05), longer transplant hospitalization ( P = .04), lower UNOS urgency status (2/IB vs 1A) at transplant ( P = .04), and Hispanic ethnicity ( P = .05). Hospital readmission occurs frequently in the first year following discharge after heart transplantation with highest risk in the first 30 days. Infection is more common than rejection as cause for readmission, with death during readmission being rare. A number of patient factors are associated with higher risk of readmission. A fuller understanding of these risk factors may help tailor strategies to reduce unnecessary hospital readmission.