Outcomes of early hospital readmission after kidney transplantation: Perspectives from a Canadian transplant centre

BACKGROUND Early hospital readmissions(EHRs)after kidney transplantation range in incidence from 18%-47%and are important and substantial healthcare quality indicators.EHR can adversely impact clinical outcomes such as graft function and patient mortality as well as healthcare costs.EHRs have been extensively studied in American healthcare systems,but these associations have not been explored within a Canadian setting.Due to significant differences in the delivery of healthcare and patient outcomes,results from American studies cannot be readily applicable to Canadian populations.A better understanding of EHR can facilitate improved discharge planning and long-term outpatient management post kidney transplant.AIM To explore the burden of EHR on kidney transplant recipients(KTRs)and the Canadian healthcare system in a large transplant centre.METHODS This single centre cohort study included 1564 KTRs recruited from January 1,2009 to December 31,2017,with a 1-year follow-up.We defined EHR as hospitalizations within 30 d or 90 d of transplant discharge,excluding elective procedures.Multivariable Cox and linear regression models were used to examine EHR,late hospital readmissions(defined as hospitalizations within 31-365 d for 30-d EHR and within 91-365 d for 90-d EHR),and outcomes including graft function and patient mortality.RESULTS In this study,307(22.4%)and 394(29.6%)KTRs had 30-d and 90-d EHRs,respectively.Factors such as having previous cases of rejection,being transplanted in more recent years,having a longer duration of dialysis pretransplant,and having an expanded criteria donor were associated with EHR post-transplant.The cumulative probability of death censored graft failure,as well as total graft failure,was higher among the 90-d EHR group as compared to patients with no EHR.While multivariable models found no significant association between EHR and patient mortality,patients with EHR were at an increased risk of late hospital readmissions,poorer kidney function throughout the 1st year post-transplant,and higher hospital-based care costs within the 1st year of follow-up.CONCLUSION EHRs are associated with suboptimal outcomes after kidney transplant and increased financial burden on the healthcare system.The results warrant the need for effective strategies to reduce post-transplant EHR.

Trend analysis of cancer incidence and mortality in China

The National Central Cancer Registry of China(NCCRC)updated their nationwide statistics of cancer incidence and mortality in China according to 2013 population-based cancer registration data(due to the time required for data collection,quality control and analysis,the latest cancer statistics available in China have a 3-year lag behind the current year).In this report,the NCCRC provides a comprehensive review of cancer incidence and mortality rates,as well as the statistics overall and by geographical area,cancer sites or age groups(Chen et al.,2017a).It shows that the burden of cancer

Current status of surgical treatment of rectal cancer in China

With the changing lifestyle and the acceleration of aging in the Chinese population,the incidence and mortality of colorectal cancer(CRC)have risen in the last decades.On the contrary,the incidence and mortality of CRC have continued to decline in the USA since the 1980s,which is mainly attributed to early screening and standardized diagnosis and treatment.Rectal cancer accounts for the largest proportion of CRC in China,and its treatment regimens are complex.At present,surgical treatment is still the most important treatment for rectal cancer.Since the first Chinese guideline for diagnosis and treatment of CRC was issued in 2010,the fourth version has been revised in 2020.These guidelines have greatly promoted the standardization and internationalization of CRC diagnosis and treatment in China.And with the development of comprehensive treatment methods such as neoadjuvant chemoradiotherapy,targeted therapy,and immunotherapy,the post-operative quality of life and prognosis of patients with rectal cancer have improved.We believe that the inflection point of the rising incidence and mortality of rectal cancer will appear in the near future in China.This article reviewed the current status and research progress on surgical therapy of rectal cancer in China.