30-Day Readmission Rate After Organ Transplantation

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Sources

Canadian Organ Replacement Register and Hospital Morbidity Database, Canadian Institute for ��ϱ� Information.

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Sources

Canadian Organ Replacement Register and Hospital Morbidity Database, Canadian Institute for ��ϱ� Information.

Methodology

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Identifying Information

Name

30-Day Readmission Rate After Organ Transplantation

Short/Other Names

Not applicable

Description

The percentage of organ transplant recipients who were urgently readmitted to a hospital within 30 days of discharge from the hospital

Background, Interpretation and Benchmarks

Rationale

Urgent readmissions to acute care facilities are increasingly being used to measure institutional or regional quality of care and care coordination.

Readmission rates can be influenced by a variety of factors, including the quality of inpatient and outpatient care, the effectiveness of the care transition and coordination, and the availability and use of effective community-based disease management programs. While not all unplanned readmissions are avoidable, interventions during and after a hospitalization can be effective in reducing readmission rates.

Interpretation

Lower rates are desirable.

HSP Framework Dimension

��ϱ� system outputs: Appropriate and effective

Targets/Benchmarks

Not applicable

Availability of Results

Available Data Years

2017 to 2023 (calendar years)

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National
Province/Territory

Organ
Age
Sex
Donor type
Diagnosis category
Neighbourhood income quintile of patient residence
Patient urban, rural or remote residence

Result Updates

Indicator Results

Not applicable

Update Frequency

Every year

Latest Results Update Date

December 2024

Updates

Not applicable

Indicator Calculation

Description

Rate = Number of transplant recipients readmitted within 30 days of discharge after the transplantation surgery hospitalization ÷ Number of hospitalizations where an organ transplantation occurred x 100

Unit of analysis: Hospitalization

Type of Measurement

Percentage or proportion

Denominator

Description:

Number of hospitalizations where a kidney, liver, heart, lung or kidney–pancreas transplantation occurred

Inclusions:

Age 18 or older
The first transplantation intervention in the hospitalization was for a kidney, liver, heart, lung or kidney–pancreas

Hospitalization data is from the Hospital Morbidity Database (HMDB) and is supplemented with data from the Canadian Organ Replacement Register (CORR) as follows:

Organ transplants in the HMDB have code 1.GR.85.^^, 1.GT.85.^^, 1.HY.85.^^, 1.HZ.85.^^, 1.NK.85.^^, 1.NP.85.^^, 1.OA.85.^^, 1.OJ.85.^^, 1.OK.85.^^ or 1.PC.85.^^. Only those where the status attribute code is not A (abandoned) are considered.
Transplantation episodes are linked to CORR data using the patient’s health care number and surgery date (plus or minus 1 day). In the case of duplicate linkages, the best match is chosen using the following priorities:
1. If available, choose the record where the CORR surgery date matches the HMDB episode start date.
2. Otherwise, choose the record where the CORR surgery date matches the HMDB episode end date.
3. Otherwise, choose the record with the lowest CORR recipient treatment ID.
A select, small number of data elements come from CORR when the records link. All other data comes from the HMDB.

Transplanted organs are defined as the following:

Kidney: CORR organ type code beginning with 1; HMDB CCI code 1.PC.85.^^
Liver: CORR organ type code beginning with 2; HMDB CCI code 1.OA.85.^^
Heart: CORR organ type code 30; HMDB CCI code 1.HZ.85.^^
Lung: CORR organ type code beginning with 4; HMDB CCI code 1.GR.85.^^ or 1.GT.85.^^
��Ա��𲹲Գ��𲹲�: For a single treatment, CORR organ type codes beginning with 1 and with 5, excluding 52; HMDB CCI code 1.OK.85.XU-XX-K or 1.OK.85.XV-XX-K; or for a single surgical episode, HMDB CCI codes 1.OK.85.^^ and 1.PC.85.^^

For kidney transplants, results are shown separately for first and second kidney transplants. For records that link to CORR, the graft number determines this. For records that do not link to CORR, a kidney transplant was considered a first transplant if the same patient did not have a previous kidney transplant reported in the HMDB since 2013. Records that did not link to CORR were not assigned to the second kidney category.

Exclusions:

HMDB: Discharge was due to death (disposition code 07, 72, 73 or 74)
HMDB: The hospitalization’s major clinical category (MCC) was mental diseases and disorders (MCC 17) or pregnancy and childbirth (MCC 13)
HMDB: Most responsible diagnosis of palliative care (ICD-10-CA code Z51.5)
HMDB: Submitting province is Quebec and most responsible diagnosis is cancer (ICD-10-CA code C00–C97) and ICD-10-CA code Z51.5 is coded in any secondary diagnosis field
For organs other than kidneys, the first transplantation procedure in the hospitalization was an organ re-transplantation:
1. CORR: Graft number is greater than 1
2. HMDB: A previous transplantation of the same organ had occurred in the same patient since 2013
The first transplantation procedure in the hospitalization involved transplantation of several organ types, except for a kidney–pancreas transplant. This is defined as either
1. CORR: Records for multiple organ types for 1 surgery, or organ type code 43 or 90
2. HMDB: Multiple codes for organ transplants (as defined in the inclusion criteria) in the same surgical episode
Invalid health care number or code for province issuing health care number

Numerator

Description:

Number of transplant recipients readmitted within 30 days of discharge after the transplantation surgery hospitalization

Inclusions:

Emergent or urgent (non-elective) readmission to an acute care hospital (Admission Category Code U and Facility Type Code 1)
The difference between the admission date on the readmission record and the discharge date of the transplantation hospitalization is less than or equal to 30 days

Exclusions:

Within the HMDB, please note the following exclusions:

Hospitalization is for delivery (ICD-10-CA code O10–O16, O21–O29, O30–O37, O40–O46, O48, O60–O69, O70–O75, O85–O89, O90–O92, O95, O98 or O99 with a sixth digit of 1 or 2; or Z37 recorded in any diagnosis field)
Chemotherapy for neoplasm (ICD-10-CA code Z51.1) is coded as diagnosis type M, 1, C, W, X or Y
Admission is for mental illness (MCC 17)
Admission is for palliative care (ICD-10-CA code Z51.5 coded as MRDx); for Quebec data: Z51.5 coded as MRDx, or cancer (C00–C97) coded as MRDx and Z51.5 coded in any secondary diagnosis field
2018–2019 data onward: Medical assistance in dying (MAID) (discharge disposition code 73)
Records with an invalid admission date

Geographic Assignment

Place of service

Data Sources

CORR
HMDB

Quality Statement

Caveats and Limitations

To align with the methodologies of other Readmission indicators, the HMDB is used as the main data source for transplantations. Consequently, the number of organ transplants reported by this indicator may not match the number reported when CORR is the primary data source.

The HMDB does not code retransplant status. For records where the HMDB transplant record does not link to CORR, the status of a transplant as a first transplant is derived through longitudinal linkage. This has the following impacts:

If a patient had a previous transplant before 2014, with a different health care number or in a different province, their retransplant may be erroneously classified as a first transplant. This has the biggest impact for Quebec data as CORR data for Quebec is not available, and for Manitoba as Manitoba health care numbers sent to the HMDB are encrypted and therefore not linkable to CORR or to other provinces in cases of longitudinal care outside of province.
Assignment to the second kidney transplant group is done only for records where CORR data links. The group may be undercounted and is not reported for Quebec.

Comments

Not applicable

References

Not applicable