Early Hospital Readmission (EHR) in kidney transplantation: a review article

J Bras Nefrol. 2020 Mar 20;42(2):231-237. doi: 10.1590/2175-8239-JBN-2019-0089.
[Article in English, Portuguese]

Abstract

Early hospital readmission (EHR), defined as all readmissions within 30 days of initial hospital discharge, is a health care quality measure. It is influenced by the demographic characteristics of the population at risk, the multidisciplinary approach for hospital discharge, the access, coverage, and comprehensiveness of the health care system, and reimbursement policies. EHR is associated with higher morbidity, mortality, and increased health care costs. Monitoring EHR enables the identification of hospital and outpatient healthcare weaknesses and the implementation of corrective interventions. Among kidney transplant recipients in the USA, EHR ranges between 18 and 47%, and is associated with one-year increased mortality and graft loss. One study in Brazil showed an incidence of 19.8% of EHR. The main causes of readmission were infections and surgical and metabolic complications. Strategies to reduce early hospital readmission are therefore essential and should consider the local factors, including socio-economic conditions, epidemiology and endemic diseases, and mobility.

A Readmissão Hospitalar Precoce (RH), definida como todas as readmissões dentro de 30 dias após a alta hospitalar inicial, é uma métrica da qualidade hospitalar. É influenciada pelas características demográficas da população em risco, pela abordagem multidisciplinar da alta hospitalar inicial, pelo acesso, pela cobertura e pela abrangência do Sistema de Saúde e pelas políticas de reembolso. A readmissão hospitalar precoce está associada a maior morbidade, mortalidade e aumento dos custos com saúde. O monitoramento da RH permite a identificação das fragilidades hospitalares e ambulatoriais e a implementação de intervenções corretivas. Entre os receptores de transplante renal nos EUA, a RH varia entre 18% e 47% e está associada a maior mortalidade e perda do enxerto no primeiro ano do transplante. Um estudo no Brasil mostrou uma incidência de 19,8% de RH. As principais causas de readmissão foram infecções e complicações cirúrgicas e metabólicas. As estratégias para reduzir a readmissão hospitalar precoce são, portanto, essenciais e devem considerar o ambiente local, incluindo condições socioeconômicas, epidemiologia local, doenças e mobilidade endêmicas.

Publication types

  • Review

MeSH terms

  • Adult
  • Brazil / epidemiology
  • Delivery of Health Care / economics
  • Female
  • Follow-Up Studies
  • Graft Survival
  • Humans
  • Incidence
  • Infections / complications
  • Infections / epidemiology
  • Insurance, Health, Reimbursement / legislation & jurisprudence
  • Interdisciplinary Communication
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / economics
  • Kidney Transplantation / mortality*
  • Kidney Transplantation / statistics & numerical data*
  • Male
  • Metabolic Diseases / complications
  • Metabolic Diseases / epidemiology
  • Middle Aged
  • Patient Discharge
  • Patient Readmission / economics
  • Patient Readmission / statistics & numerical data*
  • Patient Readmission / trends
  • Postoperative Complications / epidemiology
  • Risk Factors
  • Transplant Recipients / statistics & numerical data