Dialysis Patient Death Rates Linked to Hospital Readmissions

Dialysis patients who were readmitted to a hospital within 30 days of discharge were up to twice as likely to die compared with those not readmitted, an AHRQ study found. Researchers examined nearly 300,000 dialysis patient admissions from 2010 to 2013. Of those, 23 percent resulted in a readmission within 30 days of discharge. More than one-third of readmissions occurred within a week of discharge, and about 6 percent occurred on the same day. Recent policies propose penalizing dialysis facilities for 30-day readmissions, but this study suggested that facilities may often have limited time and opportunities to influence readmissions. Regardless of timing, patients with readmissions had a higher risk of death within one year. Access the abstract of the article, which was published in Kidney International.

2017 May 20. pii: S0085-2538(17)30228-4. doi: 10.1016/j.kint.2017.03.025. [Epub ahead of print]

Early hospital readmission among hemodialysis patients in the United States is associated with subsequent mortality.

Plantinga LC1, King L2, Patzer RE3, Lea JP4, Burkart JM5, Hockenberry JM6, Jaar BG7.

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Abstract

Dialysis providers in the United States may soon be held accountable for their patients' 30-day hospital readmissions. However, few studies have evaluated the timing of readmissions, which determines the window in which dialysis providers could act to prevent readmission. We therefore examined the timing of readmissions of hemodialysis patients in the United States and its association with mortality among 285,795 prevalent adult Medicare-primary hemodialysis patients from a national registry. Patients had at least one hospitalization in 2010-2013 (first index) and survived for 30 days or more. Readmission timing was defined as 0-7, 8-14, or 15-30 days after the index discharge. Multivariable Cox proportional hazards models were used to estimate the association between readmission timing (referent no readmission) and mortality, censored at one year. Overall, 23.1% of patients had readmissions within 30 days of the index discharge, of which over one-third (35.9%) were within the first week. Regardless of timing, patients with readmissions had a higher risk of death within one year, compared to those with no readmissions, with hazard ratios of 2.04 (95% confidence interval 2.00-2.09) for being readmitted within 15-30 days; 1.98 (1.93-2.04) for being readmitted within 8-14 days; and 1.76 (1.71-1.80) for being readmitted within 0-7 days. Thus, opportunities for dialysis providers to intervene and prevent early readmission may be limited. Regardless of the timing, readmission appears independently associated with a substantially increased risk of mortality in this population.