Rates of and Reasons for Hospital Readmissions in Patients With Cirrhosis: A Multistate Population-based Cohort Study

Tapper, Elliot B.; Halbert, Brian; Mellinger, Jessica L.

doi:10.1016/j.cgh.2016.04.009

Cited by 183 publications

(211 citation statements)

References 19 publications

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“…This has also been seen in other studies, specifically Tapper et al [7] where it was noted that encephalopathy was most strongly associated with readmission within 30 and 90 days. In addition to those with higher MELD scores, perhaps targeting patients with hepatic encephalopathy would be a prudent approach at decreasing readmission rates in those with ESLD.…”

Section: Discussionsupporting

confidence: 66%

Hospital based initiative to decrease readmission rates in end-stage liver disease

Reddy¹,

Javia²,

Halegoua-DeMarzio³

2016

Trends in Transplant

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Aim: To assess whether implementation of the care coordination program reduces 30-day readmissions, and identify characteristics that increase susceptibility to readmission. Methods:Our institution is an urban quaternary care liver transplant center performing approximately 50 liver transplants yearly in highly competitive UNOS Region 2. Our care coordination program focuses on patient education, short-term outpatient follow-up visits, and post-discharge follow-up calls by a transplant coordinator. During inpatient admission, patients deemed high-risk by attending hepatologists were enrolled. A retrospective chart review was conducted for all patients enrolled in care coordination from September 2014-April 2015. Basic demographic information, including age, gender, and ethnicity was collected. In addition, model for end-stage liver disease (MELD) score on index admission, as well as type of cirrhosis decompensation was recorded.Results: A total of 69 patients deemed high-risk for readmission were enrolled in the CC program. Of these patients, 30-day readmissions occured in 46.3%. There was no significant difference between MELD score on index admission for those readmitted within 30 days, and those who were not. Patients that were readmitted twice within a 30 day period, however, had an average MELD on index admission higher than those not readmitted within 30 days, with trend toward significance (24.3 vs. 19.1, p=0.07). Hepatic encephalopathy was the There were no differences between cirrhosis etiology, race, or type of decompensations between groups. A total of 15 post-transplant patients were included. Of those post-transplant patients who were readmitted within 30 days, the majority of them had recurrent HCV cirrhosis. Conclusion:Higher MELD scores portend increased chance of readmission, with encephalopathy being the most common reason for readmission.

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Section: Discussionsupporting

confidence: 66%

Hospital based initiative to decrease readmission rates in end-stage liver disease

Reddy¹,

Javia²,

Halegoua-DeMarzio³

2016

Trends in Transplant

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“…These data, however, come from tertiary care referral centers where readmissions may occur outside the tertiary care health system. Recently, Tapper et al4 reported in a multistate population‐based cohort a 30‐day readmission rate of 12.9% and a 90‐day readmission rate of 21.2%, much lower than those of previous studies. However, the data lacked the necessary variables required to determine risk factors for both admission and readmission, and it was unclear whether the admission was the first hospitalization for cirrhosis 4.…”

Section: Introductionmentioning

confidence: 72%

“…A report of a multistate population‐based cohort study showed the 30‐day rate of readmission to be only 12.9% 4. It is unclear how precise the diagnosis of cirrhosis was in that study and whether the admission was the first for complications of cirrhosis; cirrhosis severity was not known, and long‐term outcomes were not available.…”

Section: Discussionmentioning

confidence: 96%

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Chirapongsathorn¹,

Krittanawong

Enders

et al. 2018

Hepatology Communications

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We examined risks for first hospitalization and the rate, risk factors, costs, and 1‐year outcome of 30‐day readmission among patients admitted for complications of cirrhosis. Data were retrospectively analyzed for adult patients with cirrhosis residing in Minnesota, Iowa, or Wisconsin and admitted from 2010 through 2013 at both campuses of the Mayo Clinic Hospital in Rochester, MN. Readmission was captured at the two hospitals as well as at community hospitals in the tristate area within the Mayo Clinic Health System. The incidence of hospitalization for complications of cirrhosis was 100/100,000 population, with increasing age and male sex being the strongest risks for hospitalization. For the 2,048 hospitalized study patients, the overall 30‐day readmission rate was 32%; 498 (24.3%) patients were readmitted to Mayo Clinic hospitals and 157 (7.7%) to community hospitals, mainly for complications of portal hypertension (52%) and infections (30%). Readmission could not be predicted accurately. There were 146 deaths during readmission and an additional 105 deaths up to 1 year of follow‐up (50.4% total mortality). Annual postindex hospitalization costs for those with a 30‐day readmission were substantially higher ($73,252) than those readmitted beyond 30 days ($62,053) or those not readmitted ($5,719). At 1‐year follow‐up, only 20.4% of patients readmitted within 30 days were at home. In conclusion, patients with cirrhosis have high rates of hospitalization, especially among men over 65 years, and of unscheduled 30‐day readmission. Readmission cannot be accurately predicted. Postindex hospitalization costs are high; nationally, the annual costs are estimated to be more than $4.45 billion. Only 20% of patients readmitted within 30 days are home at 1 year. (Hepatology Communications 2018;2:188–198)

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“…1,2 While resource utilization can be intense, it may not be matched with the patient’s needs. Liver transplantation is the only definitive treatment for end-stage liver disease but many are not candidates.…”

mentioning

confidence: 99%

“…This cohort included 13,818 people, capturing 30.8% of all liver related deaths in England between 2013 and 2015.This group of patients was particularly sick, notably with a higher-than-expected 52.5% 30 day re-admission rate. 1,4 Hudson et al specifically evaluated the impact of LVPs provided by day-case units. This outpatient model provides same-day procedures as an alternative to hospitalization for patients with symptomatic ascites.…”

mentioning

confidence: 99%

Towards patient-centred and cost-effective care for patients with cirrhosis and ascites

Thomson

Tapper

2018

The Lancet Gastroenterology & Hepatology

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Rates of and Reasons for Hospital Readmissions in Patients With Cirrhosis: A Multistate Population-based Cohort Study

Cited by 183 publications

References 19 publications

Hospital based initiative to decrease readmission rates in end-stage liver disease

Hospital based initiative to decrease readmission rates in end-stage liver disease

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Towards patient-centred and cost-effective care for patients with cirrhosis and ascites

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