Purpose
The purpose of this study was to identify factors influencing the readmission of heart transplant recipients through survival analysis. Methods: We collected data from heart transplant recipients who were discharged after surgery between November 2005 and September 2020 from the electronic medical records of Y University Hospital in Seoul. The Kaplan-Meier estimation was utilized to calculate the survival rate, and Cox's proportional hazards model was employed to determine the factors influencing readmission within 1 year. Results: Out of 150 heart transplant recipients, 81 (54.0%) were readmitted within one year. The median time to readmission was 231 days. An increased duration of postoperative days was associated with a higher risk of readmission (p=.016). Groups with abnormal sodium levels (p<.001), those requiring postoperative hemodialysis (p=.013), patients with chronic kidney disease (p=.002), dyslipidemia (p=.040), or diabetes mellitus (p=.045) also faced higher readmission risks. In the final model, sodium levels (hazard ratio [HR]=2.31, p<.001) and chronic kidney disease (HR=1.67, p=.045) were significant risk factors for readmission (x² =31.90, p<.001). Conclusion: Interventions to improve kidney function and a multidisciplinary approach are needed to reduce readmission of heart transplant recipients.

Purpose
The purpose of this study was to identify the incidence and risk factors associated with the unplanned removal of nasogastric (NG) tubes in neurocritical patients.
Methods
Data were collected retrospectively from the medical records of 479 patients admitted to the tertiary hospital's neuro-intensive care units (NCU). Subjects were divided into two groups depending on whether there was unplanned NG tube removal. Multivariate logistic regression analysis was used to identify risk factors.
Results
Unplanned removal of NG tubes occurred in 35.9% of patients. The incidence of unplanned NG tube removal was 47.2 per 1,000 patient days. Intubated time of the NG tube was 3.96 days in patients with unplanned removal. Risk factors associated with unplanned removal were men (Odds Ratio [OR]=2.19), epilepsy (OR=9.99), traumatic brain injury (OR=5.50), stroke (OR=4.42), improvement of Glasgow Coma Scale (GCS) (OR=1.08), delirium (OR=1.88), physical restraint (OR=2.44), and drainage or decompression purpose (OR=1.67).
Conclusion
Unplanned removal of NG tubes occurred very frequently in neurocritical patients. Care should be taken for patients with neurological diseases who show improvement in their level of consciousness but are still confused due to brain lesions or delirium to reduce it. The application of physical restraints cannot guarantee the prevention of unplanned NG tube removal. Therefore, nurses need to assess the condition of patients and NG tubes frequently.In particular, more attention should be paid to using NG tubes for decompression or drainage purposes. It is also proposed to actively review the NG tube removal plan through periodic evaluation.

Citations

• Impact of the restraint decision tree for physical restraint use in South Korean neurointensive care units
  Jaejin Kang, Sol Kim, Minji Lee, Hyunjoo Na
  Nursing in Critical Care.2024; 29(5): 1110.     CrossRef