Clinical correlates,outcomes and healthcare costs associated with early mechanical ventilation after kidney transplantation |
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Authors: | Hui Yuan Janet E Tuttle-Newhall Mark Dy-Liacco Mark A Schnitzler Nino Dzebisashvili Huiling Xiao David Axelrod Brian Holt Krista L Lentine |
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Institution: | 1. Department of Anesthesia, Saint Louis University School of Medicine, St Louis, MO, USA;2. Department of Surgery, Saint Louis University School of Medicine, St Louis, MO, USA;3. Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH, USA;4. Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA |
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Abstract: | BackgroundInformation is lacking on the frequency, clinical implications, and costs of respiratory failure requiring mechanical ventilation after kidney transplantation.MethodsUS 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.ResultsPost-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.ConclusionsRecognition of patients at risk for post-transplantation respiratory failure may help direct protocols for reducing the incidence and consequences of this complication. |
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Keywords: | Graft failure Health care costs Kidney transplantation Mechanical ventilation Medicare |
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