Thirty‐Day Readmission and Cost Analysis in Patients With Cirrhosis: A Nationwide Population‐Based Data

Abstract

Accurate population‐based data are needed on the rate, economic impact, and the long‐term outcomes of readmission among patients with cirrhosis. To examine the rates, costs, and 1‐year outcomes of patients readmitted within 30 days following their index hospitalization for complications of cirrhosis, we conducted a nationwide, population‐based cohort study involving all patients with cirrhosis in Thailand from 2009 through 2013, using data from the National Health Security Office databases, which included those from nationwide hospitalizations. Readmission was captured from hospitals at all health care levels across the country within the Universal Coverage Scheme. For the 134,038 patients hospitalized with cirrhosis, the overall 30‐day readmission rate was 17%. Common causes of readmission consisted of complications of portal hypertension (47%) and infections (17%). After adjusting for multiple covariates, predictors of 30‐day readmission included hepatocellular carcinoma (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.84‐2.06), human immunodeficiency virus–related admission (OR 1.81, 95% CI 1.51‐2.17) and cholangiocarcinoma (OR 1.64, 95% CI 1.3‐2.05). In all, 2,936 deaths (13%) occurred during readmission, and an additional 14,425 deaths up to 1 year (63.5% total mortality among readmitted patients). Causes of death were mostly from liver‐related mortality. Average cost at index admission for those with a 30‐day readmission were significantly higher than those readmitted beyond 30 days or not readmitted. Conclusions: Patients hospitalized with cirrhosis complications had high rates of unscheduled 30‐day readmission. Average hospitalization costs were high, and only 36.5% of patients readmitted within 30 days survived at 1 year.

In-Hospital Outcomes of Patients with Acute Decompensated Heart Failure and Cirrhosis: An Analysis of the National Inpatient Sample

“…The treatment and management of cirrhosis has greatly improved in recent years, yet the economic burden has remained high over time. The overall healthcare costs of liver cirrhosis encompass high direct costs (medications and hospitalization costs) totaling 2.5 billion dollars and high indirect costs (loss of work productivity and reduced health-related quality of life) totaling 10.6 million dollars yearly [ 4 ]. This patient population is extremely vulnerable to any external or internal stress on the body as well [ 3 ].…”

“…There have been very few studies on cirrhotic cardiomyopathy [ 5 ]. Cardiac dysfunction in patients with cirrhosis is due to impaired contractility secondary to stress, diastolic dysfunction, and electrical abnormalities manifesting as prolonged QT intervals [ 4 , 5 ]. Our objective was to determine if patients with both ADHF from all etiologies and cirrhosis would have increased mortality, hospital LOS, and total hospital charges compared to patients with only ADHF.…”

Thirty-Day Unplanned Readmission and Its Effect on 90-Day Mortality in Hepatocellular Carcinoma Patients Undergoing Partial Hepatectomy

“…However, we found that male sex was associated with a 29% increased odds of 30day unplanned readmission. One explanation may be the negative role of liver fibrosis/cirrhosis in readmission [21] . Our study showed that 41.9% of males had severe fibrosis or cirrhosis compared to 32.6% of females who had the same condition (p < 0.001).…”

Risk Stratification Score to Predict Readmission of Patients With Acute Decompensated Cirrhosis Within 90 Days

“…An estimated 27.1% of readmissions may be avoidable (5). To date, several studies have focused on assessing the predictors of readmission in decompensated cirrhosis (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). However, hospital readmission rates of patients with cirrhosis remain high, ranging from 10 to 50%, with a pooled estimate of 26% at 30 days and 21-71% at 90 days (19).…”