Liver

60 - Predictors for Early Readmission in Cirrhosis in the United States - A Nationwide Population-based Study

Wednesday, October 10
9:20 AM - 9:30 AM
Location: Terrace Ballroom 4 (level 400)

Category: Liver
Chandraprakash Umapathy, MD, MS1, Priyadarshini Loganathan, MD2, Christopher Dodoo, MS2, Mahesh Gajendran, MD, MPH2
1University of California San Francisco Fresno, Fresno, CA; 2Texas Tech University Health Sciences Center, El Paso, TX

Introduction: Decompensated cirrhosis is one of most common causes of hospital readmissions in the United States. It leads to more than 150,000 hospitalizations costing nearly $4 billion dollars each year, and the incidence of hospitalizations due to complications of cirrhosis is increasing. The aim of our study is to determine the national readmission rates in cirrhosis, determine the causes and predictors of readmission.

Methods: We identified patients with Cirrhosis from the 2014 Healthcare Cost and Utilization Project (HCUP) National Readmission Database (NRD) by using ICD-9 codes.  Primary outcomes of interest were 30 and 90 day readmissions. The cause for readmission was extracted from the primary and secondary diagnosis fields.  Multivariable logistic regression model was used to identify the factors and complications associated with readmission.  All analyses were carried out using Stata v.15.

Results: There were 12,599 patients with a diagnosis of cirrhosis (mean age 56.4 ± 11.3 years, 37% female). Among them, 55% were readmitted within 30 days and 84% were readmitted within 90 days. There was no difference in readmissions among patients with alcohol related cirrhosis and non-alcohol related cirrhosis (54.6% vs 54.6%, p=0.974). In the multivariate analysis, cirrhosis caused by alcohol was less likely to lead to readmission than non-alcohol related cirrhosis (odds ratio (OR) 0.91, p=0.020). Weekend admissions (OR 1.17, p=0.001), hospital bed-size (big vs small: OR 1.12, p=0.048), patients transferred to other facilities including skilled nursing facility (OR 1.45, p<0.001), patients discharged with home health care (OR 1.26, p<0.001), were associated with increased risk of readmission. Private, not-for-profit hospitals were less likely to have a readmission as compared to a government owned hospital (OR 0.87, p=0.005). The most common complications that led to an increased risk of readmission were ascites, hepatic encephalopathy, and hepatorenal syndrome (OR 1.53, 1.10, and 1.72 respectively), with portal hypertension (OR 0.87) and variceal bleeding (OR 0.59) having lower odds of readmission.

Discussion: Cirrhosis is associated with high 30 and 90 day readmission. The 30-day readmission rate in this study is 55%, which is much higher than previous studies. Hepatorenal syndrome is most strongly associated with readmission. Quality improvement efforts should focus on optimizing the management of complications of cirrhosis.


Disclosures:
Chandraprakash Umapathy indicated no relevant financial relationships.
Priyadarshini Loganathan indicated no relevant financial relationships.
Christopher Dodoo indicated no relevant financial relationships.
Mahesh Gajendran indicated no relevant financial relationships.

Chandraprakash Umapathy

Gastroenterology and Hepatology Fellow
University of California San Francisco Fresno
Fresno, California

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