2016 - IPTA Fellows Meeting


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Mini Oral Abstract Presentations

18.61 - Hospital Readmissions in Children Following Orthotopic Heart Transplantation: Do Social Factors Matter?

Presenter: Neha, Bansal, Detroit, United States
Authors: Neha Bansal, Sanjeev Aggarwal

Hospital Readmissions in Children Following Orthotopic Heart Transplantation: Do Social Factors Matter?

Neha Bansal1, Sanjeev Aggarwal1.

1Pediatric Cardiology, Children's Hospital of Michigan, Detroit, MI, United States

Background: Children following orthotopic heart transplantation (OHT) require lifelong immunosuppression and periodic surveillance for rejection. They are at risk for hospital readmissions (HR) and emergency room (ER) visits for various emergent and elective indications. There is a paucity of data on factors affecting HR and ER visits in this population.

Objective: To examine social factors affecting HRs and ER visits in patients following OHT.

Design/Methods: We undertook a retrospective chart review of patients following OHT at our hospital over a 15-year period. Patients > 18 years old and with incomplete data were excluded. Demographic data, clinical characteristics and details of ER visits and HRs were extracted. HR for non-elective reasons were recorded. ER visits were defined as visits that did not result in HR. Descriptive statistics (SPSS ver. 19) were performed.

Results: A total of 73 patients, 37 (51%) of whom were males, survived to discharge home after OHT at a mean±SD age of 5.7 (7.5) years. The indications of OHT included cardiomyopathy in 36 (49%), CHD in 35 (48%) and re-transplant in 2 (3%). The mean duration of follow-up was 7.8 (3.6) years, during which 9 (12%) patients died. Total HR in the first 3 years after OHT were 275, a mean±SD of 4.9 (3.9) per patient. The average number of ER visits per patient in initial 3 years was 2.03 (2.16). When patients (n= 32) with HR >3 were compared with those who had ≤3 HR (n= 24), the diagnosis before OHT, gender distribution, race, insurance, caregiver’s education level (high school vs. college educated), protective services involvement, substance abuse and mental illness in family were comparable. Single parents (p=0.047) and food stamp assistance (p=0.05) were more frequent in children with higher HR. In the subgroup of infants < 1yr with OHT (n=23), the group with higher HRs had lower caregiver education level (p= 0.027).

Conclusions: Children undergoing OHT have high health care utilization, especially in the first year and 12% late mortality. Contrary to popular belief, social factors have limited impact on the health care utilization pattern in this fragile population. However, caregiver’s education, single parenthood and household economic status seem to have impact on HR.


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