TY - JOUR
T1 - Pre-kidney transplant lower extremity impairment and transplant length of stay
T2 - A time-to-discharge analysis of a prospective cohort study
AU - Nastasi, Anthony J.
AU - Bryant, Tyler S.
AU - Le, Jimmy T.
AU - Schrack, Jennifer
AU - Ying, Hao
AU - Haugen, Christine E.
AU - Fernández, Marlís González
AU - Segev, Dorry L.
AU - McAdams-Demarco, Mara A.
N1 - Funding Information:
This work was supported by the National Institutes of Health [grant numbers R01 AG042504, K24 DK101828 to D.L.S.]; the National Institute on Aging and Johns Hopkins University Claude D. Pepper Older Americans Independence Center [grant number P30 AG021334 to M.M.D.]; and the National Institute on Aging [grant number R01 AG055781 to M.M.D.; K01 AG043501 to M.M.D., grant number K01 AG048765 to J.S., grant number T32 AG000247 to J.T.L., grant number F32 AG053025 to C.E.H.]. The funding bodies had no role in: 1) the design of the study, 2) the collection, analysis, and interpretation of the data or 3) the writing of the manuscript.
Publisher Copyright:
© 2018 The Author(s).
PY - 2018/10/19
Y1 - 2018/10/19
N2 - Background: Few objective tests can be performed at admission for kidney transplantation [KT] to discern risk of increased length of stay [LOS], which is important for patient counseling and is associated with increased costs and mortality. The short physical performance battery [SPPB] is an easily administered, potentially modifiable, 3-part test of lower extremity function. SPPB score is associated with longer hospital LOS in older adults, and may provide similar utility in KT recipients given that ESRD is a disease of accelerated aging. The aim of this study was to characterize the association between SPPB-derived lower extremity function and LOS. Methods: The SPPB was administered at KT admission in a prospective cohort of 595 recipients (8/2009-6/2016). The independent association between SPPB impairment (score ≤ 10) and LOS was tested with an adjusted conventional generalized gamma parametric survival model. Results: Impaired recipients experienced longer LOS (median: 10 vs. 8 days; P < 0.001) with the greatest difference in percent discharged on day 10 (impaired: 54.5%, unimpaired: 73.3%). Discharge typically took 13% longer in the impaired group (relative time = 1.13; 95%CI: 1.05, 1.21, P = 0.001). Discharge for impaired recipients compared to unimpaired was least likely at day 5 (hazard ratio = 0.71; 95% CI:0.68, 0.74, P < 0.001). No differences in the SPPB impairment-LOS relationship were found by age (interaction P = 0.74). Conclusions: Pre-KT SPPB impairment was independently associated with longer LOS regardless of age, indicating that it is a useful, objective tool for pre-KT risk assessment in younger and older recipients that may help inform discharge planning.
AB - Background: Few objective tests can be performed at admission for kidney transplantation [KT] to discern risk of increased length of stay [LOS], which is important for patient counseling and is associated with increased costs and mortality. The short physical performance battery [SPPB] is an easily administered, potentially modifiable, 3-part test of lower extremity function. SPPB score is associated with longer hospital LOS in older adults, and may provide similar utility in KT recipients given that ESRD is a disease of accelerated aging. The aim of this study was to characterize the association between SPPB-derived lower extremity function and LOS. Methods: The SPPB was administered at KT admission in a prospective cohort of 595 recipients (8/2009-6/2016). The independent association between SPPB impairment (score ≤ 10) and LOS was tested with an adjusted conventional generalized gamma parametric survival model. Results: Impaired recipients experienced longer LOS (median: 10 vs. 8 days; P < 0.001) with the greatest difference in percent discharged on day 10 (impaired: 54.5%, unimpaired: 73.3%). Discharge typically took 13% longer in the impaired group (relative time = 1.13; 95%CI: 1.05, 1.21, P = 0.001). Discharge for impaired recipients compared to unimpaired was least likely at day 5 (hazard ratio = 0.71; 95% CI:0.68, 0.74, P < 0.001). No differences in the SPPB impairment-LOS relationship were found by age (interaction P = 0.74). Conclusions: Pre-KT SPPB impairment was independently associated with longer LOS regardless of age, indicating that it is a useful, objective tool for pre-KT risk assessment in younger and older recipients that may help inform discharge planning.
KW - Kidney transplantation
KW - Length of stay
KW - Survival analysis
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U2 - 10.1186/s12877-018-0940-y
DO - 10.1186/s12877-018-0940-y
M3 - Article
C2 - 30340462
AN - SCOPUS:85055073219
SN - 1471-2318
VL - 18
JO - BMC geriatrics
JF - BMC geriatrics
IS - 1
M1 - 246
ER -