S1065 Hospital Readmissions in Decompensated Cirrhosis: An Analysis of Predictive and Preventable Factors

Le résumé fourni par la source

Introduction: Decompensated cirrhosis can result in frequent hospitalizations leading to higher mortality and health care costs. The aim of this study was to analyze factors responsible for readmission within 30 days of discharge in patients with decompensated cirrhosis. Methods: As part of a quality improvement project, we performed a retrospective study of patients admitted with decompensated cirrhosis from 02/2017 to 05/2020. Primary outcome was days to first readmission. Clinical and demographic data were collected to describe predictors of time to readmission within 30 days of discharge, including post-discharge status, social/case management consult and outpatient follow-up. Univariate and multivariate analyses were performed to describe variables associated with days to readmission. Results: There were 398 readmissions for 235 patients; mean age was 56, 63% male, 28% had diabetes mellitus (DM), 47% hypertension (HTN), and 20% chronic kidney disease (CKD). Most common disease etiologies were alcohol (39%), HCV (14%) and NASH (14%). While 233 (59%) were single readmission within 30 days of discharge, 165 (41%) had >1 readmission (range 2-10). The median days to readmission was 13 (1-30). Common liver-related causes for readmission were hepatic encephalopathy (39%), ascites (28%) and variceal bleeding (8%) which were similar between the index admission and the readmission. Approximately 33% of readmissions were due to medication non-compliance and 54% were readmitted with the same complication as their index admission. We observed longer days to readmission among former alcohol users (15 days) compared to active alcohol (11 days) and no use (13 days) (p < 0.0068). Other variables including etiology of liver disease, MELD, comorbidities (DM, HTN, CKD), day of discharge, length of stay, admitting service, hepatology consult, or social/case manager consult did not impact the days to readmission. Conclusion: We found a large number of 30-day readmissions at our center. While the overall cause of readmissions was similar to the index admission, approximately half were for a different liver-related cause. Because 28% of readmissions were within 7 days of discharge whereas average days to outpatient follow up was 35 days with appointment date only provided to 40%, and one third were from medication non-compliance, our data support the need for additional post-discharge care coordination, with earlier follow-up to reduce hospital readmissions and reduce overall costs in those with decompensated cirrhosis.Figure 1.: Cause for readmissions in decompensated cirrhosis within 30 days of Discharge.Table 1.: Characteristics of Readmission of patients with decompensated cirrhosis

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.