Improving the perioperative value of care for vulnerable kidney transplant recipients

Background: The increased use of marginal donors, an aging recipient population, and Diagnosis-Related Group (DRG) cost restraints place significant pressures on kidney transplant centers to maintain financial viability while sustaining high quality outcomes. We engaged in a quality initiative in delayed graft function (DGF) kidney transplant recipients aimed at improving safe and efficient discharge.

Study design: This was a retrospective analysis of national databases comparing the perioperative outcomes and costs for our transplant center and national benchmark values for kidney recipients undergoing transplantation between October 2008 and March 2012. During this time, we developed and implemented quality initiatives aimed at improving health care value for kidney transplant recipients, and focused efforts particularly in patients who developed DGF. Pediatric patients and multiorgan transplant recipients were excluded.

Results: There were 583 kidney transplants performed at our institution; these were compared with 37,712 transplants available from national data. Rates of DGF increased at our institution from 6% to 25% but were steady at 27% nationally. The quality initiatives improved hospital length of stay (LOS) in DGF patients from an average of 8 days initially to 4 days at study end, which reduced overall LOS from 3.6 ± 1.5 days to 3.3 ± 0.8 days (p = 0.021); national LOS was consistent at a mean of 10 days; hospital costs decreased by 42% at our institution, while national rates rose by 12%. Our institutional 30-day readmission rates in all patients and those with DGF were significantly lower than national rates across the entire study period (9% vs 15% and 12% vs 18%, respectively).

Conclusions: These results demonstrate that health care value can be significantly improved in kidney transplant recipients, particularly in DGF patients, by implementing a multidisciplinary initiative aimed at safely and efficiently discharging patients.