Affiliation:
1. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA;
2. Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas USA;
3. Division of Gastroenterology, Hepatology and Nutrition, University of Florida College of Medicine, Gainesville, Florida USA;
4. Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana USA.
Abstract
INTRODUCTION:
Hospital readmissions are common in patients with cirrhosis, but there are few studies describing readmission preventability. We aimed to describe the incidence, causes, and risk factors for preventable readmission in this population.
METHODS:
We performed a prospective cohort study of patients with cirrhosis hospitalized at a single center between June 2014 and March 2020 and followed up for 30 days postdischarge. Demographic, clinical, and socioeconomic data, functional status, and quality of life were collected. Readmission preventability was independently and systematically adjudicated by 3 reviewers. Multinomial logistic regression was used to compare those with (i) preventable readmission, (ii) nonpreventable readmission/death, and (iii) no readmission.
RESULTS:
Of 654 patients, 246 (38%) were readmitted, and 29 (12%) were preventable readmissions. Reviewers agreed on preventability for 70% of readmissions. Twenty-two (including 2 with preventable readmission) died. The most common reasons for readmission were hepatic encephalopathy (22%), gastrointestinal bleeding (13%), acute kidney injury (13%), and ascites (6%), and these reasons were similar between preventable and nonpreventable readmissions. Preventable readmission was often related to paracentesis timeliness, diuretic adjustment monitoring, and hepatic encephalopathy treatment. Compared with nonreadmitted patients, preventable readmission was independently associated with racial and ethnic minoritized individuals (odds ratio [OR] 5.80; 95% CI, 1.96–17.13), nonmarried marital status (OR 2.88; 95% CI, 1.18–7.05), and admission in the prior 30 days (OR 3.45; 95% CI, 1.48–8.04).
DISCUSSION:
For patients with cirrhosis, readmission is common, but most are not preventable. Preventable readmissions are often related to ascites and hepatic encephalopathy and are associated with racial and ethnic minorities, nonmarried status, and prior admissions.
Funder
National Institutes of Health
National Institute of Health
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Gastroenterology,Hepatology