A nationwide analysis of re-operation after kidney transplant

  • Zhobin Moghadamyeghaneh University of Miami
  • Linda J. Chen University of Miami
  • Mahmoud Alameddine University of Miami
  • Joshua S. Jue University of Miami
  • Anupam K. Gupta University of Miami
  • George Burke University of Miami
  • Gaetano Ciancio University of Miami

Abstract

Introduction: We aimed to report the rate and short-term outcomes of patients undergoing re-operation following kidney transplant in the U.S.

Methods: The Nationwide Inpatient Sample (NIS) database was used to examine the clinical data of patients undergoing kidney transplant and re-operation during same the hospitalization from 2002‒2012. Multivariate regression analysis was performed to compare outcomes of patients with and without re-operation.

Results: We sampled a total of 35 058 patients who underwent kidney transplant. Of these, 770 (2.2%) had re-operation during the same hospitalization. Re-operation was associated with a significant increase in mortality (30.4% vs. 3%; adjusted odds ratio [AOR] 4.62; p<0.01), mean total hospital charges ($249 425 vs. $145 403; p<0.01), and mean hospitalization length of patients (18 vs. 7 days; p<0.01). The most common day of re-operation was postoperative Day 1. Hemorrhagic complication (64.2%) was the most common reason for re-operation, followed by urinary tract complications (9.9%) and vascular complications (3.6%). Preoperative coagulopathy (AOR 3.35; p<0.01) was the strongest predictor of need for re-operation, hemorrhagic complications (AOR 3.08; p<0.01), and vascular complications (AOR 2.50; p<0.01). Also, hypertension (AOR 1.26; p<0.01) and peripheral vascular disorders (AOR 1.25; p=0.03) had associations with hemorrhagic complications.

Conclusions: Re-operation after kidney transplant most commonly occurs on postoperative Day 1 and occurs in 2.2% of cases. It is associated with significantly increased mortality, hospitalization length, and total hospital charges. Hemorrhage is the most common complication. Preoperative coagulopathy is the strongest factor predicting the need for re-operation, vascular complications, and hemorrhagic complications.

Author Biography

Gaetano Ciancio, University of Miami

Brandon and Kyle Simonsen Professor of Surgery and Urology

Chief Medical Officer of the Miami Transplant Institute/Jackson Memorial Hospital

Chief Academic Officer of the Miami Transplant Institute

Director of Advanced Uro-Oncology Surgery-Jackson Memorial Hospital

University of Miami Miller School of Medicine 

Published
2017-11-01
How to Cite
Moghadamyeghaneh, Z., Chen, L., Alameddine, M., Jue, J., Gupta, A., Burke, G., & Ciancio, G. (2017). A nationwide analysis of re-operation after kidney transplant. Canadian Urological Association Journal, 11(11), E425-30. https://doi.org/10.5489/cuaj.4369
Section
Original Research