ED visits, admissions common after abdominal transplants

Last Updated: 2015-07-10

By Shannon Aymes

NEW YORK (Reuters Health) - Patients who've received an abdominal organ transplant have a high frequency of postoperative emergency department visits and hospital admissions, a new study shows.

"Several recent publications have focused on the high rates of hospital readmissions among abdominal transplant recipients," said lead author Dr. Lisa McElroy from the Northwestern University Transplant Outcomes Research Collaborative in Chicago.

"Nationally, approximately 30% of kidney transplant recipients and 50% of liver transplant recipients are readmitted within 30 days. Yet, we found very little data describing how many transplant recipients visit the ED and what proportion of those patients were readmitted," she told Reuters Health by email.

For their study, online June 4 in Transplantation, Dr. McElroy and her colleagues obtained data from the Northwestern Enterprise Data Warehouse on adult patients with a history of liver, pancreas, kidney, or multiorgan transplantation from 2008 to 2013.

Of the 1,900 transplant recipients, 37.4% visited an emergency department within one year of transplantation. The mean number of emergency department visits was 1.89 visits per study subject.

Transplant patients who required emergency department care had significantly lower survival (89.1% vs. 93.2%) and three-year graft survival (81.0% vs. 87.4%) than did patients who did not require emergency care.

They were also more likely to have received deceased donor organs (59% vs. 50%) and have longer postoperative hospital stays (5.3 days vs. 4.5 days).

Rates of emergency department visits were highest in the evenings and slightly higher on the weekends. However, the emergency department evaluation was during clinic hours in 56% of study subjects.

Gastroenterology symptoms (17%), infection (15%), and abnormal vitals or laboratory results (17%) were the most common presenting complaints.

Overall, 74% (N=998) of the transplant patients required admission to the hospital, the researchers report.

Patients with a history of liver transplantation were admitted to the hospital more often than were those with a history of kidney transplantation (78% vs. 72%); 31% of patients with a history of liver transplantation and 42% of patients with a history of kidney transplantation were discharged within 24 hours.

Requiring care in the emergency department after abdominal transplant was associated with significant decrease in graft survival. And patients with multiple emergency department visits were found to have a 16% higher risk of graft failure.

"Although it is unlikely that ED visits cause poor outcome, ED visits may be an indicator of increased risk after abdominal organ transplantation," Dr. McElroy and her colleagues write. "These patients might therefore benefit from closer postoperative monitoring such as more frequent scheduled clinic visits or lab draws."

Dr. McElroy added, "We hope the results of our study encourage clinicians and researchers to further examine the ED processes of care in place for complex surgical patients such as transplant recipients. We feel that the optimal outcome may not necessarily be a decrease in the number of transplant recipients who seek ED care, but rather the enhancement and optimization of emergency care and communication within and across clinical teams."

SOURCE: http://bit.ly/1HRWd0r

Transplantation 2015.