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Nationwide analysis of incidence and predictors of 30-day readmissions in patients with decompensated cirrhosis
  1. Mahesh Gajendran1,2,
  2. Chandraprakash Umapathy3,
  3. Abhilash Perisetti4,
  4. Priyadarshini Loganathan5,
  5. Alok Dwivedi6,
  6. Luis A Alvarado6,
  7. Marc J Zuckerman1,
  8. Hemant Goyal7,
  9. Sherif Elhanafi1
  1. 1 Paul L Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
  2. 2 Gastroenterology, UT Health San Antonio Long School of Medicine, San Antonio, Texas, USA
  3. 3 Gastroenterology and Nutrition, UT Health San Antonio Long School of Medicine, San Antonio, Texas, USA
  4. 4 Department of Gastroenterology and Hepatology, UAMS, Little Rock, Arkansas, USA
  5. 5 Department of Medicine, Texas Tech University Health Sciences Center El Paso Paul L Foster School of Medicine, El Paso, Texas, USA
  6. 6 Biostatistics and Epidemiology, Texas Tech University Health Sciences Center El Paso Paul L Foster School of Medicine, El Paso, Texas, USA
  7. 7 Gastroenterology, Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
  1. Correspondence to Dr Mahesh Gajendran, Texas Tech University Health Sciences Center El Paso Paul L Foster School of Medicine, El Paso, TX 79905, USA; mahesh.gajendran{at}ttuhsc.edu

Abstract

Background and objective Cirrhosis is the number one cause of non-cancer deaths among gastrointestinal diseases and is responsible for significant morbidity and healthcare utilisation. The objectives were to measure the 30-day readmissions rate following index hospitalisation, to determine the predictors of readmission, and to estimate the cost of 30-day readmission in patients with decompensated cirrhosis.

Methods We performed a retrospective cohort study of patients with decompensated cirrhosis using 2014 Nationwide Readmission Database from January to November. Decompensated cirrhosis was identified based on the presence of at least one of the following: ascites, hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis and hepatorenal syndrome. We excluded patients less than 18 years of age, pregnant patients, patients with missing length of stay data, and those who died during the index admission.

Results Among 57 305 unique patients with decompensated cirrhosis, the 30-day readmission rate was 23.2%. The top three predictors of 30-day readmission were leaving against medical advice (AMA), ascites and acute kidney injury, which increased the risk of readmission by 47%, 22% and 20%, respectively. Index admission for variceal bleeding was associated with a lower 30-day readmission rate by 18%. The estimated total cost associated with 30-day readmission in our study population was US$234.4 million.

Conclusion In a nationwide population study, decompensated cirrhosis is associated with a 30-day readmission rate of 23%. Leaving AMA, ascites and acute kidney injury are positively associated with readmission. Targeted interventions and quality improvement efforts should be directed toward these potential risk factors to reduce readmissions.

  • hepatic encephalopathy
  • ascites

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Data are deidentified participant data from HCUP (AHRQ).

https://doi.org/10.1136/flgastro-2021-101850

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    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Data are deidentified participant data from HCUP (AHRQ).

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    Footnotes

    • Contributors Conception and design: MG, CU, SE, MJZ. Formal analysis: MG, LAA, AD. Literature search: AP, MG, HG. First draft: MG, CU, PL. Critical revision and editing: all authors. Final approval: all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests The authors have no commercial associations or sources of support that might pose a conflict of interest. All authors have made substantive contributions to the study, and all authors endorse the data and conclusions.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.