Early hospital readmission in decompensated cirrhosis: Incidence, impact on mortality, and predictive factors

B, Morales; Planas, Ramón; Bartolı́, Ramón; Morillas, Rosa; Sala, María; Cabré, Eduard; Casas, Irma; Masnou, Helena

doi:10.1016/j.dld.2017.03.005

Cited by 41 publications

(42 citation statements)

References 34 publications

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“…The main causes of hospital readmission in our study included ascites (56%), HE (46%) and bleeding oesophageal varices (44%); all of which are associated with early rehospitalization . Similar to previous reports, we documented high 90‐day readmission rates among HE and ascites patients, indicating that preventative measures for managing these patients after discharge are inadequate …”

Section: Discussionsupporting

confidence: 85%

“…Older HE patients could be admitted because of polypharmacy . Also, similar to other reports, we identified male sex as a risk factor for readmission in our main cohort and in the ascites subgroup . Gender difference in readmission rates could reflect disparities in the propensity to access medical care post‐discharge .…”

Section: Discussionsupporting

confidence: 84%

“…7,10 Similar to previous reports, we documented high 90-day readmission rates among HE and ascites patients, indicating that preventative measures for managing these patients after discharge are inadequate. 14,15 In our analysis, predictors of readmission varied depending on clinical cause of patient decompensation, with the strength of association differing between decompensated cirrhosis groups.…”

Section: Discussionmentioning

confidence: 85%

“…Recent guidelines recommend close monitoring, prophylaxis and management of patients with decompensated cirrhosis . Despite these efforts, hospital readmissions to manage patients with decompensated cirrhosis are common . Hospital readmission rates are essential quality indicators for the healthcare system .…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, previous studies that assessed readmission rates had significant limitations, including being driven from tertiary care centre populations, not identifying predictors of readmissions unique for each decompensated feature, not using validated cirrhosis codes and/or not assessing the economic burden on the healthcare system . As such, we used the largest nationwide readmission database in the United States to estimate hospital readmission rates and evaluate the hospitalization costs among patients with cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

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Nationwide estimates and risk factors of hospital readmission in patients with cirrhosis in the United States

Shaheen

Nguyen

Congly

et al. 2019

Liver International

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Background The burden of cirrhosis on the healthcare system is substantial and growing. Our objectives were to estimate the readmission rates and hospitalization costs as well as to identify risk factors for 90‐day readmission in patients with cirrhosis. Methods We conducted a weighted analysis of the 2014 Nationwide Readmission Database to identify adult patients with cirrhosis‐related complications in the United States and assessed readmission rates at 30, 60 and 90 days post‐index hospitalization. Predictors of 90‐day readmissions were identified using weighted regression models adjusting for patient and hospital characteristics; the national estimate of hospitalization costs was also calculated. Results Of the 58 954 patients admitted with cirrhosis‐related complications in 2014, 14 910 (25%) were readmitted within 90 days because of cirrhosis‐related complications. The main causes of readmission were ascites (56%), hepatic encephalopathy (47%) and bleeding oesophageal varices (9%). Independent predictors of 90‐day readmissions were male sex (adjusted OR [aOR]: 1.08, 95% CI, 1.04‐1.13), age <60 (aOR: 1.27, 95% CI, 1.22‐1.32), privately insured (aOR: 0.74, 95% CI, 0.70‐0.77), having ≥3 comorbid conditions (aOR: 1.27, 95% CI, 1.14‐1.42) and being discharged against medical advice (aOR: 1.41, 95% CI, 1.25‐1.59). The weighted cumulative national cost estimate of the index admission was $1.8 billion, compared to $0.5 billion for readmission. Conclusions A quarter of patients admitted with cirrhosis‐related complications were readmitted within 90 days, representing a significant economic burden related to readmission of this population. Interventions and resource allocations to reduce readmission rates among cirrhotic patients is critical.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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