Hospital readmission following pediatric heart transplantation

CTOTC-04 Investigators

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Article numbere13561
JournalPediatric Transplantation
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Patient Readmission
Heart Transplantation
Pediatrics
Transplants
Infection
Organ Transplantation
Hispanic Americans
Proportional Hazards Models
Hospitalization
Fever
Clinical Trials
Incidence

Keywords

  • pediatric heart transplantation
  • readmission

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

Cite this

Hospital readmission following pediatric heart transplantation. / CTOTC-04 Investigators.

In: Pediatric Transplantation, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "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.",
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AU - Mason, Kristen L.

AU - Dipchand, Anne I.

AU - Richmond, Marc

AU - Feingold, Brian

AU - Canter, Charles E.

AU - Hsu, Daphne T.

AU - Singh, Tajinder P.

AU - Shaddy, Robert E.

AU - Armstrong, Brian D.

AU - Zeevi, Adriana

AU - Iklé, David N.

AU - Diop, Helena

AU - Odim, Jonah

AU - Webber, Steven A.

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