Incidence and predictors of 30-day readmission among patients hospitalized for advanced liver disease

Abstract

Background & aims: The rate of readmission to the hospital 30 days after discharge (30-day readmission rate) is used as a quality measure for hospitalized patients, but it has not been studied adequately for patients with advanced liver disease. We investigated the incidence and factors that predict this rate and its relationship with mortality at 90 days.

Methods: We analyzed data from patients with advanced liver disease who were hospitalized to an inpatient hepatology service at 2 large academic medical centers in 2008. Patients with elective admission and recipients of liver transplants were not included. During the study period, there were 447 patients and a total of 554 eligible admissions. Multivariate analyses were performed to identify variables associated with 30-day readmission and to examine its relationship with mortality at 90 days.

Results: The 30-day readmission rate was 20%. After adjusting for multiple covariates, readmission within 30 days was associated independently with model for end-stage liver disease scores at discharge (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.09; P = .002), the presence of diabetes (OR, 1.78; 95% CI, 1.07-2.95; P = .027), and male sex (OR, 1.73; 95% CI, 1.03-2.89; P = .038). After adjusting for age, sex, and model for end-stage liver disease score at discharge, the 90-day mortality rate was significantly higher among patients who were readmitted to the hospital within 30 days than those who were not (26.8% vs 9.8%; OR, 2.6; 95% CI, 1.36-5.02; P = .004).

Conclusions: Patients with advanced liver disease frequently are readmitted to the hospital within 30 days after discharge; these patients have a higher 90-day mortality rate than those who are not readmitted in 30 days. These data might be used to develop strategies to reduce early readmission of hospitalized patients with cirrhosis.

Figure 1

Thirty-day readmission rate (%) based on discharge MELD score categories: ≤15, >15 and ≤20, >20 and ≤30, and >30. The number of patients in each category is denoted in parentheses. The odds of 30-day readmission increased with each category of MELD score with a rate of 16%, 21%, 27%, and 29% for MELD scores of ≤15, >15 and ≤20, >20 and ≤30, and >30, respectively (overall P = .05).