Factors associated with adverse outcomes from cardiovascular events in the kidney transplant population: An analysis of national discharge data, hospital characteristics, and process measures

Amit Mathur, Yu Hui Chang, D Eric Steidley, Raymond L. Heilman, Nabil Wasif, David Etzioni, Kunam Sudhakar Reddy, Adyr A. Moss

Research output: Contribution to journalArticle

Abstract

Background: Kidney transplant (KT) patients presenting with cardiovascular (CVD) events are being managed increasingly in non-transplant facilities. We aimed to identify drivers of mortality and costs, including transplant hospital status. Methods: Data from the 2009-2011 Nationwide Inpatient Sample, the American Hospital Association, and Hospital Compare were used to evaluate post-KT patients hospitalized for MI, CHF, stroke, cardiac arrest, dysrhythmia, and malignant hypertension. We used generalized estimating equations to identify clinical, structural, and process factors associated with risk-adjusted mortality and high cost hospitalization (HCH). Results: Data on 7803 admissions were abstracted from 275 hospitals. Transplant hospitals had lower crude mortality (3.0% vs. 3.8%, p = 0.06), and higher un-adjusted total episodic costs (Median $33,271 vs. $28,022, p < 0.0001). After risk-adjusting for clinical, structural, and process factors, mortality predictors included: age, CVD burden, CV destination hospital, diagnostic cardiac catheterization without intervention (all, p < 0.001). Female sex, race, documented co-morbidities, and hospital teaching status were protective (all, p < 0.05). Transplant and non-transplant hospitals had similar risk-adjusted mortality. HCH was associated with: age, CVD burden, CV procedures, and staffing patterns. Hospitalizations at transplant facilities had 37% lower risk-adjusted odds of HCH. Cardiovascular process measures were not associated with adverse outcomes. Conclusion: KT patients presenting with CVD events had similar risk-adjusted mortality at transplant and non-transplant hospitals, but high cost care was less likely in transplant hospitals. Transplant hospitals may provide better value in cardiovascular care for transplant patients. These data have significant implications for patients, transplant and non-transplant providers, and payers.

Original languageEnglish (US)
Article number190
JournalBMC Nephrology
Volume20
Issue number1
DOIs
StatePublished - May 28 2019

Fingerprint

Process Assessment (Health Care)
Transplants
Kidney
Population
Mortality
Costs and Cost Analysis
Hospitalization
American Hospital Association
Malignant Hypertension
Hospital Costs
Cardiac Catheterization
Heart Arrest
Teaching Hospitals
Cardiac Arrhythmias
Inpatients
Patient Care
Stroke

Keywords

  • Cardiovascular disease
  • Care delivery
  • Economics
  • Kidney transplant

ASJC Scopus subject areas

  • Nephrology

Cite this

@article{115087882ab847799cf0295020df6d42,
title = "Factors associated with adverse outcomes from cardiovascular events in the kidney transplant population: An analysis of national discharge data, hospital characteristics, and process measures",
abstract = "Background: Kidney transplant (KT) patients presenting with cardiovascular (CVD) events are being managed increasingly in non-transplant facilities. We aimed to identify drivers of mortality and costs, including transplant hospital status. Methods: Data from the 2009-2011 Nationwide Inpatient Sample, the American Hospital Association, and Hospital Compare were used to evaluate post-KT patients hospitalized for MI, CHF, stroke, cardiac arrest, dysrhythmia, and malignant hypertension. We used generalized estimating equations to identify clinical, structural, and process factors associated with risk-adjusted mortality and high cost hospitalization (HCH). Results: Data on 7803 admissions were abstracted from 275 hospitals. Transplant hospitals had lower crude mortality (3.0{\%} vs. 3.8{\%}, p = 0.06), and higher un-adjusted total episodic costs (Median $33,271 vs. $28,022, p < 0.0001). After risk-adjusting for clinical, structural, and process factors, mortality predictors included: age, CVD burden, CV destination hospital, diagnostic cardiac catheterization without intervention (all, p < 0.001). Female sex, race, documented co-morbidities, and hospital teaching status were protective (all, p < 0.05). Transplant and non-transplant hospitals had similar risk-adjusted mortality. HCH was associated with: age, CVD burden, CV procedures, and staffing patterns. Hospitalizations at transplant facilities had 37{\%} lower risk-adjusted odds of HCH. Cardiovascular process measures were not associated with adverse outcomes. Conclusion: KT patients presenting with CVD events had similar risk-adjusted mortality at transplant and non-transplant hospitals, but high cost care was less likely in transplant hospitals. Transplant hospitals may provide better value in cardiovascular care for transplant patients. These data have significant implications for patients, transplant and non-transplant providers, and payers.",
keywords = "Cardiovascular disease, Care delivery, Economics, Kidney transplant",
author = "Amit Mathur and Chang, {Yu Hui} and Steidley, {D Eric} and Heilman, {Raymond L.} and Nabil Wasif and David Etzioni and Reddy, {Kunam Sudhakar} and Moss, {Adyr A.}",
year = "2019",
month = "5",
day = "28",
doi = "10.1186/s12882-019-1390-2",
language = "English (US)",
volume = "20",
journal = "BMC Nephrology",
issn = "1471-2369",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Factors associated with adverse outcomes from cardiovascular events in the kidney transplant population

T2 - An analysis of national discharge data, hospital characteristics, and process measures

AU - Mathur, Amit

AU - Chang, Yu Hui

AU - Steidley, D Eric

AU - Heilman, Raymond L.

AU - Wasif, Nabil

AU - Etzioni, David

AU - Reddy, Kunam Sudhakar

AU - Moss, Adyr A.

PY - 2019/5/28

Y1 - 2019/5/28

N2 - Background: Kidney transplant (KT) patients presenting with cardiovascular (CVD) events are being managed increasingly in non-transplant facilities. We aimed to identify drivers of mortality and costs, including transplant hospital status. Methods: Data from the 2009-2011 Nationwide Inpatient Sample, the American Hospital Association, and Hospital Compare were used to evaluate post-KT patients hospitalized for MI, CHF, stroke, cardiac arrest, dysrhythmia, and malignant hypertension. We used generalized estimating equations to identify clinical, structural, and process factors associated with risk-adjusted mortality and high cost hospitalization (HCH). Results: Data on 7803 admissions were abstracted from 275 hospitals. Transplant hospitals had lower crude mortality (3.0% vs. 3.8%, p = 0.06), and higher un-adjusted total episodic costs (Median $33,271 vs. $28,022, p < 0.0001). After risk-adjusting for clinical, structural, and process factors, mortality predictors included: age, CVD burden, CV destination hospital, diagnostic cardiac catheterization without intervention (all, p < 0.001). Female sex, race, documented co-morbidities, and hospital teaching status were protective (all, p < 0.05). Transplant and non-transplant hospitals had similar risk-adjusted mortality. HCH was associated with: age, CVD burden, CV procedures, and staffing patterns. Hospitalizations at transplant facilities had 37% lower risk-adjusted odds of HCH. Cardiovascular process measures were not associated with adverse outcomes. Conclusion: KT patients presenting with CVD events had similar risk-adjusted mortality at transplant and non-transplant hospitals, but high cost care was less likely in transplant hospitals. Transplant hospitals may provide better value in cardiovascular care for transplant patients. These data have significant implications for patients, transplant and non-transplant providers, and payers.

AB - Background: Kidney transplant (KT) patients presenting with cardiovascular (CVD) events are being managed increasingly in non-transplant facilities. We aimed to identify drivers of mortality and costs, including transplant hospital status. Methods: Data from the 2009-2011 Nationwide Inpatient Sample, the American Hospital Association, and Hospital Compare were used to evaluate post-KT patients hospitalized for MI, CHF, stroke, cardiac arrest, dysrhythmia, and malignant hypertension. We used generalized estimating equations to identify clinical, structural, and process factors associated with risk-adjusted mortality and high cost hospitalization (HCH). Results: Data on 7803 admissions were abstracted from 275 hospitals. Transplant hospitals had lower crude mortality (3.0% vs. 3.8%, p = 0.06), and higher un-adjusted total episodic costs (Median $33,271 vs. $28,022, p < 0.0001). After risk-adjusting for clinical, structural, and process factors, mortality predictors included: age, CVD burden, CV destination hospital, diagnostic cardiac catheterization without intervention (all, p < 0.001). Female sex, race, documented co-morbidities, and hospital teaching status were protective (all, p < 0.05). Transplant and non-transplant hospitals had similar risk-adjusted mortality. HCH was associated with: age, CVD burden, CV procedures, and staffing patterns. Hospitalizations at transplant facilities had 37% lower risk-adjusted odds of HCH. Cardiovascular process measures were not associated with adverse outcomes. Conclusion: KT patients presenting with CVD events had similar risk-adjusted mortality at transplant and non-transplant hospitals, but high cost care was less likely in transplant hospitals. Transplant hospitals may provide better value in cardiovascular care for transplant patients. These data have significant implications for patients, transplant and non-transplant providers, and payers.

KW - Cardiovascular disease

KW - Care delivery

KW - Economics

KW - Kidney transplant

UR - http://www.scopus.com/inward/record.url?scp=85066395529&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066395529&partnerID=8YFLogxK

U2 - 10.1186/s12882-019-1390-2

DO - 10.1186/s12882-019-1390-2

M3 - Article

C2 - 31138156

AN - SCOPUS:85066395529

VL - 20

JO - BMC Nephrology

JF - BMC Nephrology

SN - 1471-2369

IS - 1

M1 - 190

ER -