Article Figures & Data
Figures
- Figure 1.
Cumulative incidence of first emergency department visit following discharge for kidney transplantation. Cumulative incidence of time to first emergency department (ED) visit after discharge by (A) sex, (B) race/ethnicity, (C) prior ED use, and (D) primary insurance.
- Figure 2.
Rates of emergency department (ED) visits by transplant center. ID, identification.
Tables
- Table 1.
Study population characteristics compared with national adult solitary kidney transplant recipients in the United States (2009–2012)
Recipient Characteristics and Level Study Population Adult Kidney Transplant Recipients in the United States P Value Age, yr Mean±SD 51.3±13.7 51.4±13.6 0.49 Sex, % Women 40.0 39.2 0.14 Primary insurance, % Medicare 65.4 56.8 <0.001 Medicaid 5.1 4.0 Private 28.7 37.5 Other 0.8 1.7 Race/ethnicity, % White 41.5 52.3 <0.001 Black 19.1 26.0 Hispanic 22.8 14.6 Asian/Pacific Islander 8.2 5.9 Other 8.5 1.2 Year of transplant, % 2009 14.7 25.0 <0.001 2010 33.5 25.3 2011 34.7 25.1 2012 17.2 24.6 N 10,533 63,903 Recipient Characteristics and Level (% of Study Population) Rate of ED Visits after Transplantation per 100 patient-yr (95% CI) Adjusted Incidence Rate Ratio (95% CI) P Valuea Recipient age, yr 18–29 (8) 153.9 (146.5 to 161.4) 1.28 (1.20 to 1.36) <0.001 30–44 (25) 131.4 (127.6 to 135.2) 1.08 (1.04 to 1.13) 45–59 (36) 117.3 (114.3 to 120.3) 0.99 (0.95 to 1.03) 60+ (32) 127.9 (124.4 to 131.3) Reference Recipient sexb Women (40) 145.6 (142.4 to 148.8) 1.25 (1.21 to 1.29) <0.001 Men (60) 114.5 (112.2 to 116.8) Reference Recipient race Black (19) 155.5 (150.7 to 160.2) 1.21 (1.16 to 1.26) <0.001 Hispanic (23) 142.4 (138.2 to 146.6) 1.11 (1.06 to 1.15) Asian/Pacific Islander (8) 94.5 (88.8 to 100.1) 0.83 (0.78 to 0.89) Other (9) 137.1 (129.6 to 144.6) 1.15 (1.08 to 1.22) White (41) 111.0 (108.4 to 113.7) Reference Primary insurance Medicare (65) 142.2 (139.7 to 144.6) 1.44 (1.39 to 1.50) <0.001 Medicaid (5) 181.0 (171.0 to 190.9) 1.73 (1.61 to 1.85) Other (1) 112.6 (92.6 to 132.7) 1.20 (1.00 to 1.44) Private (29) 84.8 (82.0 to 87.6) Reference Discharge site Other facility (2) 180.1 (161.5 to 198.7) 1.21 (1.08 to 1.34) <0.001 Home health (19) 163.5 (158.6 to 168.3) 1.18 (1.14 to 1.22) Home/routine (80) 117.2 (115.2 to 119.2) Reference Median income on the basis of residential zip codeb Lowest income quartile (25) 141.7 (137.7 to 145.7) 0.94 (0.85 to 1.04) 0.17 Second quartile (24) 132.7 (128.7 to 136.6) 1.01 (0.96 to 1.05) Third quartile (25) 120.6 (117.0 to 124.2) 0.99 (0.95 to 1.04) Highest income quartile (25) 111.7 (108.1 to 115.3) Reference Depression Yes (4) 145.5 (135.8 to 155.1) 1.11 (1.04 to 1.19) 0.003 No (96) 126.1 (124.2 to 128.0) Reference Hypertension Yes (8) 143.6 (136.4 to 150.8) 1.05 (1.00 to 1.11) 0.07 No (92) 125.5 (123.6 to 127.5) Reference Diabetes, uncomplicated Yes (10) 123.8 (117.9 to 129.7) 1.02 (0.97 to 1.07) 0.48 No (90) 127.3 (125.3 to 129.3) Reference Diabetes, with complications Yes (19) 165.7 (160.7 to 170.6) 1.32 (1.27 to 1.36) <0.001 No (81) 118.0 (116.0 to 120.0) Reference Congestive heart failure Yes (5) 162.2 (152.2 to 172.1) 1.11 (1.04 to 1.18) <0.001 No (95) 125.3 (123.4 to 127.2) Reference Peripheral vascular disease Yes (6) 176.5 (167.2 to 185.7) 1.29 (1.22 to 1.36) <0.001 No (94) 123.9 (122.0 to 125.8) Reference Hypothyroidism Yes (8) 126.2 (119.8 to 132.6) 1.00 (0.95 to 1.06) 0.96 No (92) 127.0 (125.0 to 129.0) Reference Liver disease Yes (4) 137.8 (128.2 to 147.3) 1.08 (1.00 to 1.16) 0.05 No (96) 126.5 (124.6 to 128.4) Reference Arthritis Yes (4) 157.1 (145.7 to 168.5) 1.05 (0.98 to 1.14) 0.18 No (96) 125.9 (124.0 to 127.8) Reference Coagulopathy Yes (9) 149.5 (142.5 to 156.5) 1.12 (1.06 to 1.18) <0.001 No (91) 124.8 (122.9 to 126.8) Reference Valve disease Yes (5) 117.1 (108.6 to 125.6) 0.91 (0.84 to 0.98) <0.01 No (95) 127.4 (125.5 to 129.3) Reference Length of initial hospital stay, d 1–4 (30) 94.7 (91.7 to 97.7) Reference <0.001 5–6 (36) 118.2 (115.2 to 121.2) 1.13 (1.08 to 1.17) 7+ (34) 162.3 (158.7 to 165.3) 1.46 (1.41 to 1.53) ED visit within 1 yr before transplant Yes without admission (21) 155.1 (150.7 to 159.5) 1.58 (1.52 to 1.64) <0.001 Yes with admission (29) 177.6 (173.3 to 181.8) 1.88 (1.82 to 1.95) No (50) 87.2 (85.0 to 89.4) Reference State of residence California (47) 121.4 (118.7 to 124.1) 1.03 (0.99 to 1.07) 0.22 Florida (25) 131.5 (127.7 to 135.3) 1.00 (0.96 to 1.04) New York (28) 132.5 (128.8 to 136.2) Reference Overall population n=10,533 126.9 (125.1 to 128.8) - Table 3.
Most common primary clinical classification diagnoses codes for emergency department visits requiring and not requiring hospital admission among kidney transplant recipients postdischarge
Diagnosis Description (CCS Code)a Frequency, % ED visits requiring hospital admission Complication of device; implant or graft (237) 17.2 Essential hypertension (99) 6.5 Diabetes mellitus with complications (50) 5.6 Septicemia (2) 5.2 Fluid and electrolyte disorders (55) 4.2 Acute and unspecified renal failure (157) 3.9 Congestive heart failure; nonhypertensive (108) 3.8 Pneumonia (122) 3.6 Urinary tract infections (159) 3.6 Complications of surgical procedures or medical care (238) 3.3 Nonspecific chest pain (102) 2.1 Intestinal infection (135) 1.7 Cardiac dysrhythmias (106) 1.5 Deficiency and other anemia (59) 1.5 Skin and subcutaneous tissue infections (197) 1.3 ED visits not requiring hospital admission Abdominal pain (251) 7.8 Urinary tract infections (159) 4.9 Fluid and electrolyte disorders (55) 3.8 Nonspecific chest pain (102) 3.1 Genitourinary symptoms and ill-defined conditions (163) 3.1 Nausea and vomiting (250) 2.9 Fever of unknown origin (246) 2.8 Diabetes mellitus with complications (50) 2.7 Other gastrointestinal disorders (155) 2.7 Superficial injury; contusion (239) 2.6 Other connective tissue disease (211) 2.5 Headache; including migraine (84) 2.5 Complication of device; implant or graft (237) 2.4 Sprains and strains (232) 2.4 Skin and subcutaneous tissue infections (197) 2.2 CCS, Clinical Classifications Software; ED, emergency department.
↵a These codes describe 65% of the cumulative diagnosis classifications for the study population in ED visits requiring hospital admission and 48% of the cumulative diagnosis classifications for the study population in ED visits not requiring hospital admission.
Supplemental Data
In this issue
Emergency Department Visits after Kidney Transplantation
