Published online Oct 7, 2017. doi: 10.3748/wjg.v23.i37.6868
Peer-review started: November 29, 2016
First decision: February 9, 2017
Revised: February 24, 2017
Accepted: March 30, 2017
Article in press: March 31, 2017
Published online: October 7, 2017
To reduce readmissions and improve patient outcomes in cirrhotic patients through better understanding of readmission predictors.
We performed a single-center retrospective study of patients admitted with decompensated cirrhosis from January 1, 2011 to December 31, 2013 (n = 222). Primary outcomes were time to first readmission and 30-d readmission rate due to complications of cirrhosis. Clinical and demographic data were collected to help describe predictors of readmission, along with care coordination measures such as post-discharge status and outpatient follow-up. Univariate and multivariate analyses were performed to describe variables associated with readmission.
One hundred thirty-two patients (59.4%) were readmitted at least once during the study period. Median time to first and second readmissions were 54 and 93 d, respectively. Thirty and 90-d readmission rates were 20.7 and 30.1 percent, respectively. Predictors of 30-d readmission included education level, hepatic encephalopathy at index, ALT more than upper normal limit and Medicare coverage. There were no statistically significant differences in readmission rates when stratified by discharge disposition, outpatient follow-up provider or time to first outpatient visit.
Readmissions are challenging aspect of care for cirrhotic patients and risk continues beyond 30 d. More initiatives are needed to develop enhanced, longitudinal post-discharge systems.
Core tip: To reduce readmissions and improve patient outcomes, we conducted a retrospective cohort study of 222 decompensated cirrhotics admitted to a single institution and followed longitudinally for readmission. Nearly 60% were readmitted during the study, with hepatic encephalopathy as the most common cause of readmission, with social factors, education level and insurance, also affecting readmission rates. We also found that readmission risk in this population continues well beyond 30 d, with 30% of patients being readmitted at 90 d, calling for continued, coordinated care after hospitalization.