Rehospitalizations and emergency department visits after hospital discharge in patients receiving maintenance hemodialysis

Abstract

Clinical outcomes after a hospital discharge are poorly defined for patients receiving maintenance in-center (outpatient) hemodialysis. To describe the proportion and characteristics of these patientswho are rehospitalized, visit an emergencydepartment, or diewithin 30days after discharge froman acute hospitalization,we conducted a population-based study of all adult patients receiving maintenance in-center hemodialysis who were discharged between January 1, 2003, andDecember 31, 2011, from 157 acute care hospitals in Ontario, Canada. For patients with more than one hospitalization, we randomly selected a single hospitalization as the index hospitalization. Of the 11,177 patients included in the final cohort, 1926 (17%) were rehospitalized, 2971 (27%) were treated in the emergencydepartment, and840 (7.5%) died within 30days of discharge. Complicationsof type 2diabetesmellitus were the most common reason for rehospitalization, whereas heart failure was the most common reason for an emergency department visit. Inmultivariable analysis using a cause-specific Cox proportional hazardsmodel, the following characteristics were associated with 30-day rehospitalization: older age, the number of hospital admissions in the preceding 6 months, the number of emergency department visits in the preceding 6 months, higher Charlson comorbidity index score, and the receipt of mechanical ventilation during the index hospitalization. Thus, a large proportion of patients receiving maintenance in-center hemodialysis will be readmittedor visit an emergency room within 30 days of an acute hospitalization. A focus on improving care transitions from the inpatient setting to the outpatient dialysis unit may improve outcomes and reduce healthcare costs.