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

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Abstract

Background

Unplanned rehospitalizations (UR) within 30 days of discharge are common following lung transplantation. It is unknown whether UR represent 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 following initial discharge after lung transplantation.

Methods

This was a single-center prospective cohort study. Subjects completed a modified Short Physical Performance Battery (SPPB) to assess frailty at listing and at initial hospital discharge after transplantation and the State-Trait Anxiety Inventory (STAI) 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 ≥2 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 UR, 9 (30.0%) were deemed preventable. UR that happened before day 30 were more likely to be considered preventable than those between days 30-90 (30.0% versus 6.2%, p = 0.04). Discharge frailty, defined as SPPB<6, was the only variable associated with UR on multivariable analysis (OR = 3.4, 95% CI = 1.1-11.8, p = 0.04).

Conclusions

Although clinicians do not rate the majority of UR following lung transplant as preventable, discharge frailty is associated with UR. Further research should identify whether modification of discharge frailty can reduce UR.

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