The impact of septicemia occurring during hospitalization for renal transplantation procedures on outcomes in adults in United States

INTRODUCTION Immediate success rates of renal transplantation (RT) procedures are generally very high. National estimates of the impact of post-operative complications, specifically, septicemia occurring during hospitalization for RT's on outcomes is unclear. We sought, to examine the prevalence of septicemia in patients having renal transplantation procedures and to quantify the impact of septicemia on in-hospital mortality (IHM), length of stay (LOS), and hospital charges (HC). MATERIALS AND METHODS We performed a retrospective analysis of the Nationwide Inpatient Sample (NIS) for the years 2004 to 2010. All patients aged ≥18 years who underwent RT were selected. Association between occurrence of septicemia and outcomes (IHM, HC and LOS) was examined by multivariable linear and logistic regression models with adjustments for patient and hospital level confounders. RESULTS During the study period, 113,058 patients underwent RT, and, of these, 2459 (2.2%) developed septicemia. Characteristics included mean age (50 years), gender (males, 60%) and race (whites, 54%). Majority of RT's were performed in teaching (96%) and large institutes (85.5%). Outcomes for patients with septicemia and without septicemia, included: IHM (12.9% vs. 0.4%), discharge routinely (42.4% vs. 82.6%), mean HC ($528,980 vs. $182,165), mean LOS in days (35.2 vs 7.3), respectively, Those who developed septicemia were associated with significantly higher HC (estimate: 0.8357, 95% CI: {0.7636-0.9077}, increase of $ 247,081 from mean, p<0.0001), longer LOS (1.2116{1.1015-1.3216}, increase of 18.7 days form mean, p<0.0001) and higher IHM (Odds ratio = 31.33; {20.25-48.48}, p < 0.0001) compared to their counterparts. Increasing age (OR = 1.02 {1.01-1.02}, p<0.0001) and increase in co-morbid burden (OR = 1.57 {1.42-1.74}, p<0.0001) were associated with higher risk for developing septicemia. CONCLUSIONS Despite advances in medical/surgical care, septicemia is not an uncommon complication in patients having renal transplantation procedures and is associated with poor outcomes. Increasing age and co-morbid burden are independent predictors of occurrence of septicemia.