Inpatient rehabilitation outcomes in solid organ transplantation: Results of a unique partnership between the rehabilitation hospital and the multi-organ transplant unit in an acute hospital

Objective: To determine the outcomes in solid organ transplant recipients following inpatient rehabilitation, as a result of a unique partnership between the rehabilitation hospital and the multiorgan transplant program in an acute hospital. Design: Retrospective observational study. Setting: Community rehabilitation hospital affiliated with a university. Participants: A cohort of 173 organ transplant patients admitted consecutively over a four-year period (2004-2008) was compared to a cohort of all rehabilitation patients (n = 9762) admitted to the same inpatient rehab facility during the same period. Interventions: Inpatient rehab program to all participants. Main Outcome Measures: Length of hospital stay, Functional Independence Measure (FIM) change (admission-discharge), and rate of discharges to home. Results: Outcomes were measured using components of the FIM instrument, admission and discharge data. Chi-square and independent two-sample t-tests were used for statistical analysis. Compared to a general rehabilitation inpatient population, transplant rehabilitation inpatients had: more immediate (<3 days) transfers to an acute hospital (5.2% vs. 1.9%, p < 0.001); a higher rate of readmission to an acute hospital after the first 3 days (19.1% vs. 1.9%, p < 0.001); a longer mean length of stay (27 ± 19 vs. 20 ± 18 days, p < 0.001); a lower total FIM change (8.9 vs. 20.9, p < 0.001); a lower FIM efficiency (1.1 vs. 1.4, p < 0.001); and a higher rate of discharges to home in patients not readmitted to acute care (98.5% vs. 94.5% p < 0.001). Conclusion: Outcomes of rehabilitation in solid organ transplant patients are comparable but not identical to those in other patient groups. Inpatient rehabilitation for transplant patients is therefore fully justifiable and necessary. The ten times higher rate of transplant patient readmission to acute hospital must be communicated, facilitated, accepted and managed within a partnership strategy.