Hospital readmissions in decompensated cirrhotics: Factors pointing toward a prevention strategy

Abstract

Aim: To reduce readmissions and improve patient outcomes in cirrhotic patients through better understanding of readmission predictors.

Methods: We performed a single-center retrospective study of patients admitted with decompensated cirrhosis from January 1, 2011 to December 31, 2013 (n = 222). Primary outcomes were time to first readmission and 30-d readmission rate due to complications of cirrhosis. Clinical and demographic data were collected to help describe predictors of readmission, along with care coordination measures such as post-discharge status and outpatient follow-up. Univariate and multivariate analyses were performed to describe variables associated with readmission.

Results: One hundred thirty-two patients (59.4%) were readmitted at least once during the study period. Median time to first and second readmissions were 54 and 93 d, respectively. Thirty and 90-d readmission rates were 20.7 and 30.1 percent, respectively. Predictors of 30-d readmission included education level, hepatic encephalopathy at index, ALT more than upper normal limit and Medicare coverage. There were no statistically significant differences in readmission rates when stratified by discharge disposition, outpatient follow-up provider or time to first outpatient visit.

Conclusion: Readmissions are challenging aspect of care for cirrhotic patients and risk continues beyond 30 d. More initiatives are needed to develop enhanced, longitudinal post-discharge systems.

Keywords: Chronic care; Chronic disease; Cirrhosis; Liver disease; Re-hospitalizations; Readmissions.

Figure 1

Kaplan-Meier curve for time to readmission stratified by MELD score.

Figure 2

Kaplan-Meier curve for time to readmission stratified by etiology of cirrhosis.