Clinical predictors and outcome implications of early readmission in lung transplant recipients

Classified as probably not a substantial claim.

Prior work has linked certain pre-existing conditions to higher 30-day readmission rates after surgery.

“This finding is inconsistent with other studies, in which authors have observed significant relationships between specific pre-existing conditions and increased rates of 30-day readmission in surgical patients.7,12”

• cites [7] Kassin, 2012, Risk factors for 30-day hospital readmission among general surgery patients, J Am Coll Surg sourceSupported
• cites [12] Schneider, 2012, Patient readmission and mortality after surgery for hepato-pancreato-biliary malignancies, J Am Coll Surg J Am Coll Surg sourcePartly supported

  The Results (Readmission analyses; page unavailable) report a significant association between a higher Elixhauser comorbidity score and increased 30-day readmission after hepato-pancreato-biliary surgery. The paper measures pre-existing conditions but reports this finding for a composite score, not significant relationships with specific individual conditions. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Disseminated cancer, a pre-operative open wound, and dyspnea are examples of comorbidities tied to early readmission in prior studies.

“Examples of existing comorbidities associated with early readmission include disseminated cancer, pre-operative open wound, and dyspnea.”

• cites [7] Kassin, 2012, Risk factors for 30-day hospital readmission among general surgery patients, J Am Coll Surg sourceSupported
• cites [12] Schneider, 2012, Patient readmission and mortality after surgery for hepato-pancreato-biliary malignancies, J Am Coll Surg J Am Coll Surg sourcePartly supported

  The Results (Readmission analyses; page unavailable) associate a higher overall comorbidity score with readmission within 30 days. The paper does not identify disseminated cancer, a pre-operative open wound, or dyspnea as individual readmission risk factors; searches for those terms found no such analysis. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

In univariate analysis, post-operative pneumonia, any infection, and atrial fibrillation were each associated with increased 30-day readmission (all p < 0.05).

“By univariate analysis, post-operative complications that predisposed to 30-day readmission included pneumonia, any infection, and atrial fibrillation (all p < 0.05).”

• Also stated in: § Complications · plain

  “Significantly increased rates of readmission were observed among patients with post-operative pneumonia (p = 0.007), atrial fibrillation (p = 0.040), or infection of any kind (p = 0.016).”

The quote only partly states this claim.

Readmission episodes cost about $200,000 on average per readmitted patient.

“The average readmitted patient was charged approximately $200,000 for services provided during the readmission episode.”

• Also stated in: § Discussion · plain

  “In our patient population, the average readmission episode is associated with patient charges of nearly $200,000 per episode.”

• AssumptionRests on an assumption: Billed charges for readmission episodes reflect the true financial burden on patients and the US health care system.

Classified as probably not a substantial claim.

Removing scheduled readmissions left 795 patients for final analysis.

“Further exclusion to account for scheduled readmission left 795 patients in the final sample for analysis.”

May combine two claims.

In the adjusted multivariate model controlling for demographic factors, comorbidities, and complications, post-operative sepsis (OR 0.576; 95% CI 0.353-0.938) and occurrence of any complication (OR 1.764; 95% CI 1.259-2.470) were significant predictors of 30-day readmission.

“Post-operative sepsis (odd ratio [OR] = 0.576; 95% CI, 0.353–0.938) and occurrence of any complication (OR = 1.764; 95% CI, 1.259–2.470) both came out of the adjusted model as significant predictors of readmission at 30 days.”

Classified as probably not a substantial claim.

Excluding in-hospital deaths, repeat transplants, and multi-organ transplants left 832 patients.

“After excluding patients because of in-hospital death, repeat transplantation, and multi-organ transplantation, 832 patients were left in the sample.”

May combine two claims.

On univariate analysis, readmission status predicted chronic kidney disease at 6 months (OR 1.7; 95% CI 1.2-2.3) but did not predict mortality.

“On univariate analysis, readmission status was identified as a predictor of chronic kidney disease at 6 months (OR = 1.7; 95% CI, 1.2–2.3) but not as a predictor of mortality.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The center performed 874 primary lung transplants from January 2000 through March 2012.

“Between January 2000 and March 2012, 874 primary lung transplant procedures were performed at our center.”

May combine two claims.

Index hospitalization charges averaged $402,000 for readmitted patients and $488,000 for those not readmitted.

“This cost is in addition to an average index hospitalization cost of $402,000. In comparison, the average index hospitalization cost for patients without readmission was $488,000.”

May combine two claims.

In 2010-2011, the center performed 230 lung transplants and recorded 99 unscheduled readmissions.

“Between 2010 and 2011, 230 lung transplant procedures were performed at our center with 99 unscheduled readmissions.”

May combine two claims.

Post-operative sepsis, pulmonary embolism, and stroke trended toward significance but did not meet the 5% threshold.

“Sepsis, pulmonary embolism, and stroke in the post-operative period showed trends toward significance but were not contributors at the 5% level.”

May combine two claims.

Age, underlying diagnosis, lung allocation score, and single versus double transplant procedure were not significantly associated with differential risk of unscheduled 30-day readmission.

“Age, underlying diagnosis, lung allocation score, and transplant procedure (single vs double) were not significantly associated with differential risk for unscheduled readmission.”

May combine two claims.

Female sex was more common in the readmission group, but this difference was not statistically significant at the 5% level.

“Patient sex showed a trend toward significance with a higher proportion of female patients in the readmission group. However, this relationship did not achieve statistical significance at the 5% level.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The 12-year study period saw changes in the general approach to lung transplantation.

“Additionally, our analysis involves a period of 12 years during which the general approach to lung transplantation has changed.”

Classified as probably not a substantial claim.

To reduce unmeasured confounding, the authors included as many available variables as possible in their regression models.

“We have attempted to address this limitation by considering as many variables as were available to us for inclusion in our regression models.”

May combine two claims.

Even though readmitted patients had lower average index hospitalization costs, the expense of the readmission itself eliminates any savings from the initial stay.

“Although the index hospitalization was on average less expensive for readmitted patients, the high cost associated with the readmission episode wipes away any financial gains that may have been made from a cheaper initial hospital stay.”

• AssumptionRests on an assumption: Billed charges for readmission episodes reflect the true financial burden on patients and the US health care system.

Probably not a substantial claim: may not pass S3 (load-bearing).

The authors checked and supplemented their data through manual chart review and an institutional cardiovascular disease database.

“These data were validated, supplemented, and cross-referenced with manual chart review and with data obtained from our institutional database for cardiovascular disease.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

It is unknown how these complex patients would have fared had they not been readmitted for appropriate care.

“At the same time, we are limited in knowing what the outcomes would be for these complicated patients if they had not been readmitted for appropriate care.”

May combine two claims.

Using data from one institution limited sample size, reducing power and raising the chance of type II error.

“Second, our study was based on data from a single institution. This imposes sample size hindrances that limit power and increase the risk of type II error.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The center performs many lung transplants and handles complex cases, which could influence its readmission rate.

“Lastly, our institution is a high-volume lung transplantation center with a high case complexity, which possibly would affect our readmission rate.”

May combine two claims.

Because 30-day readmission was not linked to mortality, the authors suggest that care may still be of good quality while these patients simply need more frequent hospital care.

“Even with such striking findings from financial analysis, the lack of correlation between 30-day readmission and outcomes that are traditionally valued in medicine—such as mortality—suggests that providers may be providing “quality” care for patients, but that these kinds of patients may require more frequent inpatient health care.”

Probably not a substantial claim: may not pass S3 (load-bearing).

An institutional review board approved the study protocol.

“The study protocol was approved by the institutional review board.”