Social contributions as risk factors for readmissions after lung transplantation: Clinical and financial implications

Abstract

Introduction

Lung transplant is associated with a 60%–80% 1-year post-transplant readmission rate. Social contributors represent potentially modifiable risk factors for readmission. We compared the clinical and financial of implications of readmissions associated with and without social factors.

Methods

Retrospective single-center study of lung transplant patients surviving to discharge between 2/2/2013 and 4/11/2023. Two reviewers categorized 1-year readmissions into two groups: social (eg, housing instability or rejection due to medication non-compliance) and non-social (eg, pancreatitis). Sociodemographics, transplant indications, Stanford Integrated Psychosocial Assessment for Transplant scores, lung allocation score, pre-operative hospitalization status, in-hospital post-operative course, and readmission costs were compared between patients with and without a social readmission.

Results

Among 192 transplants (109 double, 83 single), there were 436 1-year readmissions, including 33 social readmissions. Reviewer inter-rater reliability was >95% and Kappa was 0.91. A social readmission occurred in 21 (11%) patients, and 9 of these patients had multiple social readmissions. A social readmission was either the first or second readmission for 81% of these patients. Patients with a social readmission had a greater median number of readmissions (4 vs 2; p < 0.001) and were associated with longer length of stay (8 vs 5 days; p < 0.004), increased hospital costs ($23,813 vs $14,245; p = 0.04), and decreased margin (-$6145 vs $2287; p<0.001).

Conclusions

Social readmissions represent a burden on patients and health systems. There is a strong association between social readmissions and increased costs, length of stay, and number of readmissions. Outpatient investment in patients with first-time social readmissions may improve outcomes and decrease healthcare costs.