Clinical and economic analysis of delayed administration of antithymocyte globulin for induction therapy in kidney transplantation.

CONTEXT: The increasing number of marginal deceased kidney donors and an aging recipient population, prolonged hospitalization, and increased costs have destabilized the economic viability of kidney transplants. OBJECTIVE: To determine if a delay in the administration of the day-of-discharge dose of rabbit antithymocyte globulin would result in equivalent clinical outcomes with cost savings. DESIGN: Single-center, prospective, observational before-and-after study of adult kidney transplant recipients who received induction with rabbit antithymocyte globulin.Intervention-Patients who received a transplant between June 2006 and February 2009 and received rabbit antithymocyte globulin served as the control group. Patients who received a transplant between March 2009 and August 2010 and received rabbit antithymocyte globulin had the day-of-discharge dose delayed to the following day and administered in the clinic. A total of 231 patients (146 in the control group, 85 in the study group) were included. Baseline demographic and clinical characteristics were similar in the 2 groups. RESULTS: Patients who had delayed administration of rabbit antithymocyte globulin had shorter stays (3.9 vs 3.1 days, P< .001) and reduced inpatient costs for rabbit antithymocyte globulin (mean $860/patient); these changes were achieved without affecting acute rejection rates (5% vs 5%, P> .99) or readmission rates. In conclusion, delayed inpatient administration of rabbit antithymocyte globulin provided identical clinical outcomes while helping to reduce inpatient costs and increase timely discharges.

The relationship between prescription medication use and ability to ambulate distances after spinal cord injury.

OBJECTIVE: To investigate the relationship between prescription medication use for pain and spasticity and ambulation distances while controlling for pain severity, injury severity, age, sex, and race in participants with spinal cord injury (SCI). DESIGN: Secondary analysis of survey data. SETTING: Specialty hospital in the Southeast United States. PARTICIPANTS: Adults (N=407) with traumatic SCI identified through inpatient and outpatient hospital databases. INTERVENTION: Not applicable. MAIN OUTCOMES MEASURES: A questionnaire measured prescription medication use, ambulation distance, and other demographic data. A composite score of four 10-point scales from the Brief Pain Inventory was used to measure pain severity. Multinomial logistic regression was used to calculate the odds ratio (OR) of ambulation distance using 1000 ft or more as the reference group. RESULTS: Persons with SCI who were heavy prescription medication users (defined as weekly or daily use for pain or spasticity) were more likely to be limited to distances less than 150 (OR, 2.82; 95% confidence interval [CI], 1.57-5.04) and 150 to 999 ft (OR, 2.52; 95% CI, 1.45-4.39). CONCLUSION: Heavy prescription medication use for pain and spasticity was related inversely to a person's ability to achieve community ambulation distances of 1000 ft or more.