Within 30 days of hospital discharge, 17% of adult patients receiving maintenance hemodialysis were rehospitalized, 27% visited an emergency department, and 7.5% died.
Cohort (n=11,177)
Yes
What are the rates and predictors of 30-day rehospitalization, emergency department visits, and mortality after hospital discharge in patients receiving maintenance in-center hemodialysis?
A large proportion of patients receiving maintenance in-center hemodialysis experience rehospitalization, emergency department visits, or death within 30 days of acute hospital discharge, highlighting the need for improved care transitions.
Clinical outcomes after a hospital discharge are poorly defined for patients receiving maintenance in-center (outpatient) hemodialysis. To describe the proportion and characteristics of these patients who are rehospitalized, visit an emergency department, or die within 30 days after discharge from an acute hospitalization, we conducted a population-based study of all adult patients receiving maintenance in-center hemodialysis who were discharged between January 1, 2003, and December 31, 2011, from 157 acute care hospitals in Ontario, Canada. For patients with more than one hospitalization, we randomly selected a single hospitalization as the index hospitalization. Of the 11,177 patients included in the final cohort, 1926 (17%) were rehospitalized, 2971 (27%) were treated in the emergency department, and 840 (7.5%) died within 30 days of discharge. Complications of type 2 diabetes mellitus were the most common reason for rehospitalization, whereas heart failure was the most common reason for an emergency department visit. In multivariable analysis using a cause-specific Cox proportional hazards model, the following characteristics were associated with 30-day rehospitalization: older age, the number of hospital admissions in the preceding 6 months, the number of emergency department visits in the preceding 6 months, higher Charlson comorbidity index score, and the receipt of mechanical ventilation during the index hospitalization. Thus, a large proportion of patients receiving maintenance in-center hemodialysis will be readmitted or visit an emergency room within 30 days of an acute hospitalization. A focus on improving care transitions from the inpatient setting to the outpatient dialysis unit may improve outcomes and reduce healthcare costs.
Harel et al. (Thu,) conducted a cohort in Maintenance in-center hemodialysis (n=11,177). Acute hospitalization discharge was evaluated on 30-day rehospitalization. Within 30 days of hospital discharge, 17% of adult patients receiving maintenance hemodialysis were rehospitalized, 27% visited an emergency department, and 7.5% died.