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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Paracentesis in cirrhotics is associated with increased risk of 30-day readmission
Lindsay A Sobotka, Rohan M Modi, Akshay Vijayaraman, A James Hanje, Anthony J Michaels, Lanla F Conteh, Alice Hinton, Ashraf El-Hinnawi, Khalid Mumtaz
Lindsay A Sobotka, Rohan M Modi, Akshay Vijayaraman, Department of Internal Medicine, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
A James Hanje, Anthony J Michaels, Lanla F Conteh, Khalid Mumtaz, Division of Gastroenterology, Hepatology and Nutrition, the Ohio State Wexner Medical Center, Columbus, OH 43210, United States
Alice Hinton, Division of Biostatistics, College of Public Health, the Ohio State University, Columbus, OH 43210, United States
Ashraf El-Hinnawi, Department of Surgery, the Ohio State Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: Sobotka LA, Modi RM, Vijayaraman A and Mumtaz K analyzed the data, drafted the manuscript and revised for important intellectual content; Hinton A performed the statistical analysis; Hanje AJ, Michaels AJ, Conteh LF and El-Hinnawi A revised for important intellectual content; Mumtaz K supervised the study.
Institutional review board statement: The Ohio State University Data and Specimen Policy and Human Subjects Research Policy do not require Institutional Board Review approval for population-based public data sets. Per 45 Code of Federal Regulations (CFR 46.101), research using certain publicly available data sets does not involve “human subjects.”
Informed consent statement: The Ohio State University Data and Specimen Policy and Human Subjects Research Policy do not require informed consent for research conducted using publicy available data set as they do not involve “human subject.”
Conflict-of-interest statement: None of the authors have conflicts of interest.
Data sharing statement: No additional data is available
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Khalid Mumtaz, MD, MSc, Assistant Professor, Doctor, Division of Gastroenterology, Hepatology and Nutrition, the Ohio State Wexner Medical Center, 95 West 12th Avenue, 2nd Floor, Columbus, OH 43210, United States. khalid.mumtaz@osumc.edu
Telephone: +1-614-2931456 Fax: +1-614-2936720
Received: December 22, 2018
Peer-review started: December 22, 2018
First decision: March 8, 2018
Revised: March 13, 2018
Accepted: April 11, 2018
Article in press: April 11, 2018
Published online: June 27, 2018
ARTICLE HIGHLIGHTS
Research background
Patients with decompensated cirrhosis secondary to ascites or hepatic encephalopathy are at high risk of complication and readmission. Previous studies have determined that performing a paracentesis in these patients will improve inpatient mortality; however, the effect of performing a paracentesis on 30-d readmission has not been studied.
Research motivation
Given the economic burden of readmissions, we aimed to determine the readmission rate in patients with decompensated cirrhosis with ascites and encephalopathy. Identifying factors associated with readmission are crucial to preventing unnecessary hospital admission and healthcare spending.
Research objective
The objective for this study included determining 30-d readmission rate in patients with cirrhosis with ascites or encephalopathy, reasons for readmission, factors associated with readmission and cost of readmission.
Research methods
We performed a retrospective database analysis utilizing the Nationwide Readmission Database. All adult patients with a diagnosis of cirrhosis and ascites or encephalopathy were included. Multivariate analysis was performed to assess predictors of 30-d readmission and cost of readmission.
Research results
The 30 d readmission rate in patients with cirrhosis and ascites or encephalopathy was 31% and the majority of patients were readmitted for liver related issues (58%). Paracentesis was performed on 50% of patients during the index admission. Factors associated with readmission included age under 64, Medicaid or Medicare insurance provider, greater than 3 Elixhauser comorbidities, nonalcoholic cirrhosis, hepatocellular carcinoma and undergoing a paracentesis on index admission. Cost of index admission between patients that were readmitted within 30 d and those that were not readmitted were similar; however cost of care was significantly higher for the readmission compared to the index admission.
Research conclusion
This study determined the readmission rate and economic burden of 30-d readmission in patient with cirrhosis and ascites or encephalopathy. We also highlighted multiple factors associated with readmission, specifically undergoing a paracentesis that were associated with 30 d readmission. Modifying factors associated with readmission during index admission could reduce unplanned readmissions, decrease the economic burden associated with readmission and decrease patient morbidity and mortality.
Research perspectives
Further directions for this research include implementing intervention to modify factors associated with readmission in order to determine the effect on readmission, cost and patient mortality.
