Factors associated with adverse outcomes from cardiovascular events in the kidney transplant population: an analysis of national discharge data, hospital characteristics, and process measures.
Aged
Cardiovascular Diseases
/ diagnosis
Databases, Factual
/ economics
Economics, Hospital
/ trends
Female
Hospital Mortality
/ trends
Hospitals
/ trends
Humans
Kidney Transplantation
/ economics
Length of Stay
/ economics
Male
Middle Aged
Patient Discharge
/ economics
Population Surveillance
/ methods
Process Assessment, Health Care
/ economics
Treatment Outcome
United States
/ epidemiology
Cardiovascular disease
Care delivery
Economics
Kidney transplant
Journal
BMC nephrology
ISSN: 1471-2369
Titre abrégé: BMC Nephrol
Pays: England
ID NLM: 100967793
Informations de publication
Date de publication:
28 05 2019
28 05 2019
Historique:
received:
16
12
2018
accepted:
17
05
2019
entrez:
30
5
2019
pubmed:
30
5
2019
medline:
1
9
2020
Statut:
epublish
Résumé
Kidney transplant (KT) patients presenting with cardiovascular (CVD) events are being managed increasingly in non-transplant facilities. We aimed to identify drivers of mortality and costs, including transplant hospital status. Data from the 2009-2011 Nationwide Inpatient Sample, the American Hospital Association, and Hospital Compare were used to evaluate post-KT patients hospitalized for MI, CHF, stroke, cardiac arrest, dysrhythmia, and malignant hypertension. We used generalized estimating equations to identify clinical, structural, and process factors associated with risk-adjusted mortality and high cost hospitalization (HCH). Data on 7803 admissions were abstracted from 275 hospitals. Transplant hospitals had lower crude mortality (3.0% vs. 3.8%, p = 0.06), and higher un-adjusted total episodic costs (Median $33,271 vs. $28,022, p < 0.0001). After risk-adjusting for clinical, structural, and process factors, mortality predictors included: age, CVD burden, CV destination hospital, diagnostic cardiac catheterization without intervention (all, p < 0.001). Female sex, race, documented co-morbidities, and hospital teaching status were protective (all, p < 0.05). Transplant and non-transplant hospitals had similar risk-adjusted mortality. HCH was associated with: age, CVD burden, CV procedures, and staffing patterns. Hospitalizations at transplant facilities had 37% lower risk-adjusted odds of HCH. Cardiovascular process measures were not associated with adverse outcomes. KT patients presenting with CVD events had similar risk-adjusted mortality at transplant and non-transplant hospitals, but high cost care was less likely in transplant hospitals. Transplant hospitals may provide better value in cardiovascular care for transplant patients. These data have significant implications for patients, transplant and non-transplant providers, and payers.
Sections du résumé
BACKGROUND
Kidney transplant (KT) patients presenting with cardiovascular (CVD) events are being managed increasingly in non-transplant facilities. We aimed to identify drivers of mortality and costs, including transplant hospital status.
METHODS
Data from the 2009-2011 Nationwide Inpatient Sample, the American Hospital Association, and Hospital Compare were used to evaluate post-KT patients hospitalized for MI, CHF, stroke, cardiac arrest, dysrhythmia, and malignant hypertension. We used generalized estimating equations to identify clinical, structural, and process factors associated with risk-adjusted mortality and high cost hospitalization (HCH).
RESULTS
Data on 7803 admissions were abstracted from 275 hospitals. Transplant hospitals had lower crude mortality (3.0% vs. 3.8%, p = 0.06), and higher un-adjusted total episodic costs (Median $33,271 vs. $28,022, p < 0.0001). After risk-adjusting for clinical, structural, and process factors, mortality predictors included: age, CVD burden, CV destination hospital, diagnostic cardiac catheterization without intervention (all, p < 0.001). Female sex, race, documented co-morbidities, and hospital teaching status were protective (all, p < 0.05). Transplant and non-transplant hospitals had similar risk-adjusted mortality. HCH was associated with: age, CVD burden, CV procedures, and staffing patterns. Hospitalizations at transplant facilities had 37% lower risk-adjusted odds of HCH. Cardiovascular process measures were not associated with adverse outcomes.
CONCLUSION
KT patients presenting with CVD events had similar risk-adjusted mortality at transplant and non-transplant hospitals, but high cost care was less likely in transplant hospitals. Transplant hospitals may provide better value in cardiovascular care for transplant patients. These data have significant implications for patients, transplant and non-transplant providers, and payers.
Identifiants
pubmed: 31138156
doi: 10.1186/s12882-019-1390-2
pii: 10.1186/s12882-019-1390-2
pmc: PMC6540439
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
190Références
Am J Kidney Dis. 2006 Apr;47(4):593-603
pubmed: 16564937
Circ Cardiovasc Interv. 2015 May;8(5):
pubmed: 25901044
Med Care. 2010 Mar;48(3):210-6
pubmed: 20125043
Liver Transpl. 2018 Oct;24(10):1398-1410
pubmed: 29544033
Clin J Am Soc Nephrol. 2008 Jul;3(4):1115-24
pubmed: 18417743
Am J Transplant. 2007 Mar;7(3):493-4
pubmed: 17250551
PLoS One. 2015 Jun 24;10(6):e0131237
pubmed: 26107641
Transplantation. 2011 May 27;91(10):1120-6
pubmed: 21427631
Transplant Direct. 2017 May 12;3(6):e162
pubmed: 28620646
Transplant Direct. 2017 Jan 16;3(2):e126
pubmed: 28361110
Med Care. 2018 May;56(5):416-423
pubmed: 29578952
Am J Cardiol. 2017 Feb 15;119(4):542-552
pubmed: 27939383
Health Serv Res. 2014 Dec;49(6):2000-16
pubmed: 24974769
Transpl Int. 2015 Jan;28(1):10-21
pubmed: 25081992
Biometrics. 2001 Mar;57(1):120-5
pubmed: 11252586
Transplant Proc. 2017 Nov;49(9):2092-2098
pubmed: 29149967
Clin J Am Soc Nephrol. 2009 Jul;4(7):1213-21
pubmed: 19541817
Am J Kidney Dis. 2010 Jan;55(1):152-67
pubmed: 19783341
Am J Transplant. 2009 Mar;9(3):494-505
pubmed: 19120083
Transplant Proc. 2016 Jun;48(5):1543-50
pubmed: 27496444
Int J Cardiol. 2017 Aug 1;240:82-86
pubmed: 28256327
Urology. 2016 Jan;87:88-94
pubmed: 26383614
Am J Transplant. 2009 Aug;9(8):1811-5
pubmed: 19519808
Circulation. 2012 Jul 31;126(5):617-63
pubmed: 22753303
Saudi J Kidney Dis Transpl. 2011 Jan;22(1):24-39
pubmed: 21196610