Paracentesis in cirrhotics is associated with increased risk of 30-day readmission

Abstract

AIMTo determine the readmission rate, its reasons, predictors, and cost of 30-d readmission in patients with cirrhosis and ascites.METHODSA retrospective analysis of the nationwide readmission database (NRD) was performed during the calendar year 2013. All adults cirrhotics with a diagnosis of ascites, spontaneous bacterial peritonitis, or hepatic encephalopathy were identified by ICD-9 codes. Multivariate analysis was performed to assess predictors of 30-d readmission and cost of readmission.RESULTSOf the 59597 patients included in this study, 18319 (31%) were readmitted within 30 d. Majority (58%) of readmissions were for liver related reasons. Paracentesis was performed in 29832 (50%) patients on index admission. Independent predictors of 30-d readmission included age < 40 (OR: 1.39; CI: 1.19-1.64), age 40-64 (OR: 1.19; CI: 1.09-1.30), Medicaid (OR: 1.21; CI: 1.04-1.41) and Medicare coverage (OR: 1.13; CI: 1.02-1.26), > 3 Elixhauser comorbidity (OR: 1.13; CI: 1.05-1.22), nonalcoholic cirrhosis (OR: 1.16; CI: 1.10-1.23), paracentesis on index admission (OR: 1.28; CI: 1.21-1.36) and having hepatocellular carcinoma (OR: 1.21; CI: 1.05; 1.39). Cost of index admission was similar in patients readmitted and not readmitted (P-value: 0.34); however cost of care was significantly more on 30 d readmission ($30959 ± 762) as compared to index admission ($12403 ± 378), P-value: < 0.001.CONCLUSIONCirrhotic patients with ascites have a 33% chance of readmission within 30-d. Younger patients, with public insurance, nonalcoholic cirrhosis and increased comorbidity who underwent paracentesis are at increased risk of readmission. Risk factors for unplanned readmission should be targeted given these patients have higher healthcare utilization.

Current approaches to the management of patients with cirrhotic ascites

“…It is then followed by the administration of diuretic agents and a low sodium diet[54]. Recent studies have shown the reduction in short-term mortality and an increase of hospitalization period in patients who underwent LVP[55], as well as the high probability of their repeated hospitalization within 30 d[56].…”

Timing of paracentesis and outcomes in hospitalized patients with decompensated cirrhosis

“…Only 24.5% of them were from the EP group. Another study conducted by Sobotka et al [ 25 ] found that paracentesis was associated with increased 30-d readmission. Despite this finding, paracentesis is recommended by guidelines and it is a quality indicator in cirrhotic patients.…”

Review Article: The Effect of Performing a Paracentesis on Hospital Outcomes

“…Our study utilizing the Nationwide Inpatient Sample specifically analyzed readmission rates in patient with decompensated cirrhosis with ascites and determined this specific group of patients had a 30% chance of 30 day readmission. Readmission in these patients was associated with younger age, government funded insurance, multiple comorbidities, nonalcoholic cirrhosis and hepatocellular carcinoma 5 . Another study by Volk et al predict that about 22% of these readmissions could have been prevented by better patient education and intensive outpatient monitoring 8 .…”

“…One of the most prevalent and early features of decompensation is the development of ascites 4 . The accumulation of ascites with associated discomfort and shortness of breath is one of the top ten reasons for readmission in patients with decompensated cirrhosis 5 . Multiple treatment options exist in the management cirrhosis including fluid and salt restriction, diuretics, large volume paracentesis, transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation.…”

“…Multiple treatment options exist in the management cirrhosis including fluid and salt restriction, diuretics, large volume paracentesis, transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation. Recent literature has suggested that some of these interventions may have negative effects on hospital outcomes [5][6][7][8] .…”