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. 2013;8(1):e55140.
doi: 10.1371/journal.pone.0055140. Epub 2013 Jan 28.

Risk factors for frequent readmissions and barriers to transplantation in patients with cirrhosis

Swaytha Ganesh  1 , Shari S Rogal, Dhiraj Yadav, Abhinav Humar, Jaideep Behari
Affiliations

Risk factors for frequent readmissions and barriers to transplantation in patients with cirrhosis

Swaytha Ganesh et al. PLoS One. 2013.

Abstract

Background: Hospital readmission rate is receiving increasing regulatory scrutiny. Patients with cirrhosis have high hospital readmissions rates but the relationship between frequent readmissions and barriers to transplantation remains unexplored. The goal of this study was to determine risk factors for frequent readmissions among patients with cirrhosis and identify barriers to transplantation in this population.

Methods: We retrospectively reviewed medical records of 587 patients with a confirmed diagnosis of cirrhosis admitted to a large tertiary care center between May 1, 2008 and May 1, 2009. Demographics, clinical factors, and outcomes were recorded. Multivariate logistic regression was performed to identify risk factors for high readmission rates. Transplant-related factors were assessed for patients in the high readmission group.

Results: The 587 patients included in the study had 1557 admissions during the study period. A subset of 87 (15%) patients with 5 or more admissions accounted for 672 (43%) admissions. The factors associated with frequent admissions were non-white race (OR = 2.45, p = 0.01), diabetes (OR = 2.04, p = 0.01), higher Model for End-Stage Liver Disease (MELD) score (OR = 35.10, p<0.0001 for MELD>30) and younger age (OR = 0.98, p = 0.02). Among the 87 patients with ≥5 admissions, only 14 (16%) underwent liver transplantation during the study period. Substance abuse, medical co-morbidities, and low (<15) MELD scores were barriers to transplantation in this group.

Conclusions: A small group of patients with cirrhosis account for a disproportionately high number of hospital admissions. Interventions targeting this high-risk group may decrease frequent hospital readmissions and increase access to transplantation.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. A small group of cirrhosis patients accounts for a dispropionate percentage of hospital admissions.
The percentage of patients with one or more admissions during the study period is shown.
Figure 2
Figure 2. Flowchart showing transplant-related outcomes in patients with >4 admissions.
Patients deemed to not to be transplant candidates include both referred and non-referred patients. Low MELD score patients had MELD <15.
See this image and copyright information in PMC

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