A nationwide analysis of re-operation after kidney transplant

Zhobin Moghadamyeghaneh, Linda J Chen, Mahmoud Alameddine, Joshua S. Jue, Anupam K. Gupta, George W Burke, Gaetano Ciancio

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Abstract

Introduction: We aimed to report the rate and short-Term outcomes of patients undergoing re-operation following kidney transplant in the U.S. Methods: The Nationwide Inpatient Sample (NIS) database was used to examine the clinical data of patients undergoing kidney transplant and re-operation during same the hospitalization from 2002?2012. Multivariate regression analysis was performed to compare outcomes of patients with and without re-operation. Results: We sampled a total of 35 058 patients who underwent kidney transplant. Of these, 770 (2.2%) had re-operation during the same hospitalization. Re-operation was associated with a significant increase in mortality (30.4% vs. 3%; adjusted odds ratio [AOR] 4.62; p<0.01), mean total hospital charges ($249 425 vs. $145 403; p<0.01), and mean hospitalization length of patients (18 vs. 7 days; p<0.01). The most common day of re-operation was postoperative Day 1. Hemorrhagic complication (64.2%) was the most common reason for re-operation, followed by urinary tract complications (9.9%) and vascular complications (3.6%). Preoperative coagulopathy (AOR 3.35; p<0.01) was the strongest predictor of need for re-operation, hemorrhagic complications (AOR 3.08; p<0.01), and vascular complications (AOR 2.50; p<0.01). Also, hypertension (AOR 1.26; p<0.01) and peripheral vascular disorders (AOR 1.25; p=0.03) had associations with hemorrhagic complications. Conclusions: Re-operation after kidney transplant most commonly occurs on postoperative Day 1 and occurs in 2.2% of cases. It is associated with significantly increased mortality, hospitalization length, and total hospital charges. Hemorrhage is the most common complication. Preoperative coagulopathy is the strongest factor predicting the need for re-operation, vascular complications, and hemorrhagic complications.

Original languageEnglish (US)
Pages (from-to)E425-E430
JournalCanadian Urological Association Journal
Volume11
Issue number11
DOIs
StatePublished - Nov 1 2017

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Odds Ratio
Transplants
Kidney
Blood Vessels
Hospitalization
Hospital Charges
Mortality
Urinary Tract
Inpatients
Multivariate Analysis
Regression Analysis
Databases
Hemorrhage
Hypertension

ASJC Scopus subject areas

  • Urology

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A nationwide analysis of re-operation after kidney transplant. / Moghadamyeghaneh, Zhobin; Chen, Linda J; Alameddine, Mahmoud; Jue, Joshua S.; Gupta, Anupam K.; Burke, George W; Ciancio, Gaetano.

In: Canadian Urological Association Journal, Vol. 11, No. 11, 01.11.2017, p. E425-E430.

Research output: Contribution to journalArticle

Moghadamyeghaneh, Zhobin ; Chen, Linda J ; Alameddine, Mahmoud ; Jue, Joshua S. ; Gupta, Anupam K. ; Burke, George W ; Ciancio, Gaetano. / A nationwide analysis of re-operation after kidney transplant. In: Canadian Urological Association Journal. 2017 ; Vol. 11, No. 11. pp. E425-E430.
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abstract = "Introduction: We aimed to report the rate and short-Term outcomes of patients undergoing re-operation following kidney transplant in the U.S. Methods: The Nationwide Inpatient Sample (NIS) database was used to examine the clinical data of patients undergoing kidney transplant and re-operation during same the hospitalization from 2002?2012. Multivariate regression analysis was performed to compare outcomes of patients with and without re-operation. Results: We sampled a total of 35 058 patients who underwent kidney transplant. Of these, 770 (2.2{\%}) had re-operation during the same hospitalization. Re-operation was associated with a significant increase in mortality (30.4{\%} vs. 3{\%}; adjusted odds ratio [AOR] 4.62; p<0.01), mean total hospital charges ($249 425 vs. $145 403; p<0.01), and mean hospitalization length of patients (18 vs. 7 days; p<0.01). The most common day of re-operation was postoperative Day 1. Hemorrhagic complication (64.2{\%}) was the most common reason for re-operation, followed by urinary tract complications (9.9{\%}) and vascular complications (3.6{\%}). Preoperative coagulopathy (AOR 3.35; p<0.01) was the strongest predictor of need for re-operation, hemorrhagic complications (AOR 3.08; p<0.01), and vascular complications (AOR 2.50; p<0.01). Also, hypertension (AOR 1.26; p<0.01) and peripheral vascular disorders (AOR 1.25; p=0.03) had associations with hemorrhagic complications. Conclusions: Re-operation after kidney transplant most commonly occurs on postoperative Day 1 and occurs in 2.2{\%} of cases. It is associated with significantly increased mortality, hospitalization length, and total hospital charges. Hemorrhage is the most common complication. Preoperative coagulopathy is the strongest factor predicting the need for re-operation, vascular complications, and hemorrhagic complications.",
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AU - Alameddine, Mahmoud

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AU - Gupta, Anupam K.

AU - Burke, George W

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AB - Introduction: We aimed to report the rate and short-Term outcomes of patients undergoing re-operation following kidney transplant in the U.S. Methods: The Nationwide Inpatient Sample (NIS) database was used to examine the clinical data of patients undergoing kidney transplant and re-operation during same the hospitalization from 2002?2012. Multivariate regression analysis was performed to compare outcomes of patients with and without re-operation. Results: We sampled a total of 35 058 patients who underwent kidney transplant. Of these, 770 (2.2%) had re-operation during the same hospitalization. Re-operation was associated with a significant increase in mortality (30.4% vs. 3%; adjusted odds ratio [AOR] 4.62; p<0.01), mean total hospital charges ($249 425 vs. $145 403; p<0.01), and mean hospitalization length of patients (18 vs. 7 days; p<0.01). The most common day of re-operation was postoperative Day 1. Hemorrhagic complication (64.2%) was the most common reason for re-operation, followed by urinary tract complications (9.9%) and vascular complications (3.6%). Preoperative coagulopathy (AOR 3.35; p<0.01) was the strongest predictor of need for re-operation, hemorrhagic complications (AOR 3.08; p<0.01), and vascular complications (AOR 2.50; p<0.01). Also, hypertension (AOR 1.26; p<0.01) and peripheral vascular disorders (AOR 1.25; p=0.03) had associations with hemorrhagic complications. Conclusions: Re-operation after kidney transplant most commonly occurs on postoperative Day 1 and occurs in 2.2% of cases. It is associated with significantly increased mortality, hospitalization length, and total hospital charges. Hemorrhage is the most common complication. Preoperative coagulopathy is the strongest factor predicting the need for re-operation, vascular complications, and hemorrhagic complications.

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