J'undra N Pegues, Reem M Fawaz, Kinka M Kimfon, Hechuan Hou, Pierre-Emmanuel Noly, Thomas M Cascino, Robert B Hawkins, James W Stewart Ii, Keith Aaronson, Jennifer Cowger, Francis D Pagani, Donald S Likosky
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引用次数: 0
Abstract
Background: Heart transplantation (HT) survival and waitlist times are established outcome metrics. Patient-centered HT outcomes are insufficiently characterized. This study evaluates the role of days alive and outside the hospital (DAOH) as a candidate patient-centered HT performance measure.
Methods: The study cohort included Medicare beneficiaries undergoing HT (July 2008-December 2017). The percent of days outside of hospital (%DOH) 6 months before (%DOH-BF) and percent of days alive outside of hospital 12 months after HT (%DAOH-AF) were evaluated along with adverse events (AEs, early: ≤3 months; late: 4-12 months). Patients were stratified by patient %DAOH-AF terciles. Risk-adjusted %DAOH was evaluated across hospitals.
Results: A total of 5,104 beneficiaries underwent HT across 108 hospitals. Median [interquartile range (IQR)] age was 62 [53-67] years, 23.9% were female, and 21.4% were African-American. The overall median %DOAH-AF was 92.9% [83.8%, 95.9%], varying by tercile: low 71.8% [4.9%, 83.6%], intermediate 92.9% [91%, 94%]; high 96.4% [95.9%, 97.3%]. The lowest (vs highest) tercile %DAOH-AF had a lower median %DOH-BF (88% [73%-97%] vs 92% [81%-98%]) and longer post-HT inpatient stay (54 [36-81] vs 13 [10-15] days). After HT, the lowest versus highest tercile had greater AEs burden in the early (allograft failure [16.1% vs 1.6%], stroke [12.1% vs 2.3%]) and late (stroke [5.1% vs 1.9%], sternal wound infection [5.0% vs 0.8%]) phases post-HT. The mean hospital %DAOHadj was 80.5% (min:max 57.7%-96.7%).
Conclusions: Post-HT %DAOH varies across beneficiaries and hospitals and is associated with AEs. Further research is warranted to assess the role and validity of %DAOH as an HT quality metric.
期刊介绍:
The Journal of Heart and Lung Transplantation, the official publication of the International Society for Heart and Lung Transplantation, brings readers essential scholarly and timely information in the field of cardio-pulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.