30-Day Readmission Rate After Organ Transplantation

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

Lower rates are desirable.

Data updated:
Data availability: to (calendar years)
Geographic coverage
All provinces/territories
Reporting level
National, Province/Territory
Calculation

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

Unit of analysis: Hospitalization

Denominator

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

Numerator

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

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Sources

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

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Notes

Certain metric values were suppressed or modified for confidentiality reasons in accordance with CIHI’s privacy policy. These values are identified with the text “Suppressed” in the data tables and hover-over tool tip.

The dash (—) indicates that no data is available. Select different parameters or reset the chart.

Sources

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

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Name

30-Day Readmission Rate After Organ Transplantation

Short/Other Names

Not applicable

Description

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

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

Appropriate and effective

Targets/Benchmarks

Not applicable

Available Data Years

to

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

Indicator Results

Not applicable

Update Frequency

Every year

Latest Results Update Date

Updates

Not applicable

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

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:

  1. Age 18 or older 
  2. 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:

  1. 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.
  2. Transplantation episodes are linked to CORR data using the patient’s health card 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.
  3. If a CORR record links, information on organs transplanted comes from CORR. Otherwise, information comes from the HMDB.

Transplanted organs are defined as the following:

  1. Kidney: CORR organ type code beginning with 1; HMDB CCI code 1.PC.85.^^
  2. Liver: CORR organ type code beginning with 2; HMDB CCI code 1.OA.85.^^
  3. Heart: CORR organ type code 30; HMDB CCI code 1.HZ.85.^^
  4. Lung: CORR organ type code beginning with 4; HMDB CCI code 1.GR.85.^^ or 1.GT.85.^^
  5. Kidney–pancreas: 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:

  1. Discharge was due to death (disposition code 07, 72, 73 or 74)
  2. The hospitalization’s major clinical category (MCC) was mental diseases and disorders (MCC 17) or pregnancy and childbirth (MCC 13)
  3. Most responsible diagnosis of palliative care (ICD-10-CA code Z51.5)
  4. 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
  5. For organs other than kidneys, the first transplantation procedure in the hospitalization was an organ retransplantation:
    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
  6. 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
  7. Invalid health card number or code for province issuing health card number

Numerator

Description:

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

Inclusions:

  1. Emergent or urgent (non-elective) readmission to an acute care hospital (Admission Category Code U and Facility Type Code 1)
  2. 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:

  1. 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)
  2. Chemotherapy for neoplasm (ICD-10-CA code Z51.1) is coded as diagnosis type M, 1, C, W, X or Y
  3. Admission is for mental illness (MCC 17)
  4. 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
  5. 2018–2019 data onward: Medical assistance in dying (MAID) (discharge disposition code 73)
  6. Records with an invalid admission date

Geographic Assignment

Place of service

Data Sources

  • CORR
  • HMDB

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 — for Quebec and Manitoba — in a different province, their retransplant may be erroneously classified as a first transplant. This has the biggest impact for Quebec data, where data from CORR is not available.
  • 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.

Trending Issues

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Comments

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References

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