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

Courtwright, Andrew, M., MD, PhD1; Zaleski, Derek2; Gardo, Lisa1; Ahya, Vivek, N.1; Christie, Jason, D.1; Crespo, Maria1; Hadjiliadis, Denis1; Lee, James1; Molina, Maria3; Patel, Namrata1; Porteous, Mary1; Cantu, Edward, E.3; Bermudez, Christian3; Diamond, Joshua, M.1

doi: 10.1097/TP.0000000000002101
Original Clinical Science—General

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

Methods This was a single-center prospective cohort study. Subjects completed a modified short physical performance battery to assess frailty at listing and at initial hospital discharge after transplantation and the State-Trait Anxiety Inventory 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 of 2 or higher 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 URs, 9 (30.0%) were deemed preventable. Unplanned rehospitalization that happened before day 30 were more likely to be considered preventable than those between days 30 and 90 (30.0% versus 6.2%, P = 0.04). Discharge frailty, defined as short physical performance battery less than 6, was the only variable associated with UR on multivariable analysis (odds ratio, 3.4; 95% confidence interval, 1.1-11.8; P = 0.04).

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

Discharge frailty, defined as a modified Short Physical Performance Battery < 6, is the only variable associated with unplanned rehospitalizations (UR) following lung transplantation and 30% of UR are likely to be considered preventable.

1 Pulmonary and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA.

2 Good Shepard Penn Partners, Philadelphia, PA.

3 Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, PA.

Received 27 August 2017. Revision received 20 November 2017.

Accepted 6 December 2017.

Support for this research was provided by National Institutes of Health grants (5T32-HL-007633-30, K23-HL-121406, and K24-HL-115354). The sponsors had no role in the design of the study, the collection and analysis of the data, or preparation of the article.

The authors declare no conflicts of interest.

A.M.C., D.Z., L.G., and J.M.D. participated in research design, writing of the article, performance of the research, data analysis, and approval of the final article. V.N.A., J.D.C., M.C., D.H., J.L., M.M., N.P., M.P., E.E.C., and C.B. participated in research design, performance of the research, and approval of the final article.

Correspondence: Joshua M. Diamond, Allergy and Critical Care Medicine Division, Hospital of the University of Pennsylvania Pulmonary, 821, West Gates 3400, Spruce St, Philadelphia, PA 19104. (joshua.diamond@uphs.upenn.edu).

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