959 Cirrhosis Patients Admitted With Ascites Have Longer Length of Stay and Higher 30-Day Readmission Rate

Abstract

INTRODUCTION: Hospitalizations and readmissions in cirrhosis patients pose a significant economic burden to the health care system. Readmission rates are high for patients with decompensated cirrhosis; 30-day rates are as high as 30–40%. We aimed to identify the frequency and predictors of 30-day readmission rates in patients with decompensated cirrhosis admitted to two academic hospitals. METHODS: Using research informatics and validated ICD-10 codes, we identified cirrhosis patients admitted to the University of Miami Hospital (UMH) from 10/1/2017 to 10/1/2018. (Figure 1) After retrospective chart review, we excluded patients without cirrhosis or qualifying admissions. As patients from UMH are often admitted to Jackson Memorial Hospital, those records were also reviewed for admissions during the study period. Univariate analysis was conducted to describe demographics and disease-specific characteristics and identify variables associated with 30-day readmission rates. RESULTS: In our sample, 105 patients met inclusion criteria with 208 eligible admissions. Median age was 63 and 67.6% were male. During the index admission, the primary admission diagnosis was ascites in 36 patients, upper GI bleed in 15, and hepatic encephalopathy (HE) in 13. For 41 patients, the reason for admission is listed as other. (Table 1) The average length of stay (LOS) during the index admission was 7 days (±7.5). The readmission rate was 52.7%; the 30-day readmission rate was 25.8%. Twelve patients died during the index admission. Fifty patients had at least one readmission; range (1–8). A higher proportion of ascites patients were readmitted within 30 days, 35.3%, compared to 23.1% in those with GI bleed, 27.7% of HE patients and 17.1% of those with other diagnoses. Those with ascites also had the longest LOS, mean 7.67 days (±10). Noting the above results, we focused on the 47 patients with a primary or secondary diagnosis of ascites. Average time to paracentesis was 2 days. Only one patient with ascites (2.1%) was scheduled for paracentesis prior to discharge; 38 (81.8%) were discharged on diuretics. Fourteen patients (29.8%) were readmitted with a primary diagnosis of ascites (Table 2). CONCLUSION: Patients with decompensated cirrhosis are frequently readmitted in less than 30 days; ascites contributed to increased LOS and readmission rates. Additional study is needed to determine if Implementation of core quality measures decreases readmission rates and/or improves quality of life.