Incidence and predictors of 30-day hospital readmissions for liver cirrhosis: insights from the United States National Readmissions Database

Abstract

Background: Cirrhosis is associated with substantial inpatient morbidity and mortality. This study aimed to determine the trends in 30-day hospital readmission rates among patients with cirrhosis and identify factors associated with these readmissions.Methods: We conducted a retrospective analysis of data retrieved from the Nationwide Readmissions Database to determine trends in 30-day readmission for patients discharged with a diagnosis of cirrhosis in 2010 through 2014. Multivariate logistic regression analysis was used to identify predictors of readmission.Results: Among 303,346 patients identified from the database, the 30-day readmission rate for patients with a discharge diagnosis of cirrhosis was 31.4% (n=95,298). The trends in the readmission rates remained steady during the study period. On multivariate analysis, female sex, age 45 years or older, esophagogastroduodenoscopy (EGD) during admission, and disposition to a short-term care facility or skilled nursing facility protected against readmissions. In contrast, coverage by Medicaid insurance, admission during a weekend, nonalcoholic cause of cirrhosis, and history of hepatic encephalopathy and ascites were associated with readmission. Conclusions:We found an exceptionally high 30-day readmission rate in patients with cirrhosis, although it remained stable during the study period. This study identified some modifiable factors such as disposition to a short-term care facility or skilled nursing facility and patients' attendance of alcohol rehabilitation facilities that could decrease the likelihood of readmission and could inform local and national healthcare policymakers.

Reduction in Gastrointestinal Cancers in Cirrhotic Patients Receiving Rifaximin vs Lactulose Only Therapy for Hepatic Encephalopathy

“…The increasing prevalence of cirrhosis worldwide, including USA, over the last decades is predominantly due to increasing rates of nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH), and alcoholic liver disease while there have been decreasing rates of viral hepatitis [ 2 - 4 ]. Cirrhosis is associated with higher rates of hospitalization, readmissions, longer length of hospitalization, and worse outcomes in comparison with other disease states [ 5 , 6 ]. Healthcare utilization and costs associated with cirrhosis have been rising over the last two decades [ 7 - 9 ].…”

Validation of a Guideline for Nurses Taking Care of Patients With Liver Cirrhosis in the Context of COVID-19 in the Emergency Department

“…Nurses need scientific theoretical support to construct knowledge in the face of this new reality. A study on hospital readmissions of patients with cirrhosis in emergency services highlighted that identifying the modifiable factors at admission enables the development of effective interventions to reduce the readmission risk ( Garg et al, 2021 ). With this, some suggested strategies to be implemented in the emergency services include devising tools to promote better patient safety ( Lockett, Nelson, & Hales, 2021 ).…”

“…development of effective interventions to reduce the readmission risk (Garg et al, 2021). With this, some suggested strategies to be implemented in the emergency services include devising tools to promote better patient safety (Lockett, Nelson, & Hales, 2021).…”

Hepatic encephalopathy and strategies to prevent readmission from inadequate transitions of care

“…36 Another study looking at predictors for readmissions in cirrhotic patients found a decreased incidence of readmission in patients discharged to a shortterm hospital (OR 0.71, CI 0.63-0.81) or skilled nursing facility (OR 0.86, CI 0.82-0.91) compared to those discharged to home. 45 T A B L E 1 Key domains in the ideal transitions of care model for hepatic encephalopathy…”

“…The average cost to be in the HEPACONTROL group was €517 ± 304 and when added to the readmission cost would still show cost savings 36 . Another study looking at predictors for readmissions in cirrhotic patients found a decreased incidence of readmission in patients discharged to a short‐term hospital (OR 0.71, CI 0.63–0.81) or skilled nursing facility (OR 0.86, CI 0.82–0.91) compared to those discharged to home 45 …”