TY - JOUR
T1 - Clinical correlates, outcomes and healthcare costs associated with early mechanical ventilation after kidney transplantation
AU - Yuan, Hui
AU - Tuttle-Newhall, Janet E.
AU - Dy-Liacco, Mark
AU - Schnitzler, Mark A.
AU - Dzebisashvili, Nino
AU - Xiao, Huiling
AU - Axelrod, David
AU - Holt, Brian
AU - Lentine, Krista L.
PY - 2013/11
Y1 - 2013/11
N2 - Background Information is lacking on the frequency, clinical implications, and costs of respiratory failure requiring mechanical ventilation after kidney transplantation. Methods US Renal Data System records for Medicare-insured kidney transplant recipients (1995 to 2007; n = 88,392) were examined to identify post-transplantation mechanical ventilation from billing claims within 30 days after transplantation. Results Post-transplantation mechanical ventilation was required among 2.1% of the cohort. Independent correlates of early mechanical ventilation included recipient age, low body mass index, coronary artery disease, and cerebrovascular disease. Post-transplantation mechanical ventilation was twice as likely with delayed graft function (adjusted odds ratio, 2.13; P <.001) and 35% lower among recipients of living versus deceased donor allografts. Patients needing early mechanical ventilation experienced 5-fold higher 1-year mortality, as well as significantly higher Medicare costs during the transplant hospitalization and first post-transplantation year. Conclusions Recognition of patients at risk for post-transplantation respiratory failure may help direct protocols for reducing the incidence and consequences of this complication.
AB - Background Information is lacking on the frequency, clinical implications, and costs of respiratory failure requiring mechanical ventilation after kidney transplantation. Methods US Renal Data System records for Medicare-insured kidney transplant recipients (1995 to 2007; n = 88,392) were examined to identify post-transplantation mechanical ventilation from billing claims within 30 days after transplantation. Results Post-transplantation mechanical ventilation was required among 2.1% of the cohort. Independent correlates of early mechanical ventilation included recipient age, low body mass index, coronary artery disease, and cerebrovascular disease. Post-transplantation mechanical ventilation was twice as likely with delayed graft function (adjusted odds ratio, 2.13; P <.001) and 35% lower among recipients of living versus deceased donor allografts. Patients needing early mechanical ventilation experienced 5-fold higher 1-year mortality, as well as significantly higher Medicare costs during the transplant hospitalization and first post-transplantation year. Conclusions Recognition of patients at risk for post-transplantation respiratory failure may help direct protocols for reducing the incidence and consequences of this complication.
KW - Graft failure
KW - Health care costs
KW - Kidney transplantation
KW - Mechanical ventilation
KW - Medicare
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U2 - 10.1016/j.amjsurg.2013.07.008
DO - 10.1016/j.amjsurg.2013.07.008
M3 - Review article
AN - SCOPUS:84886707875
SN - 0002-9610
VL - 206
SP - 686
EP - 692
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 5
ER -