Journal Article

Risk Factors for Frequent Readmissions and Barriers to Transplantation in Patients with Cirrhosis

Ganesh, Swaytha, Rogal, Shari S., Humar, Abhinav, Behari, Jaideep, Yadav, Dhiraj

2013

Overview

Hospital readmission rate is receiving increasing regulatory scrutiny. Patients with cirrhosis have high hospital readmissions rates but the relationship between frequent readmissions and barriers to transplantation remains unexplored. The goal of this study was to determine risk factors for frequent readmissions among patients with cirrhosis and identify barriers to transplantation in this population. We retrospectively reviewed medical records of 587 patients with a confirmed diagnosis of cirrhosis admitted to a large tertiary care center between May 1, 2008 and May 1, 2009. Demographics, clinical factors, and outcomes were recorded. Multivariate logistic regression was performed to identify risk factors for high readmission rates. Transplant-related factors were assessed for patients in the high readmission group. The 587 patients included in the study had 1557 admissions during the study period. A subset of 87 (15%) patients with 5 or more admissions accounted for 672 (43%) admissions. The factors associated with frequent admissions were non-white race (OR = 2.45, p = 0.01), diabetes (OR = 2.04, p = 0.01), higher Model for End-Stage Liver Disease (MELD) score (OR = 35.10, p<0.0001 for MELD>30) and younger age (OR = 0.98, p = 0.02). Among the 87 patients with ≥5 admissions, only 14 (16%) underwent liver transplantation during the study period. Substance abuse, medical co-morbidities, and low (<15) MELD scores were barriers to transplantation in this group. A small group of patients with cirrhosis account for a disproportionately high number of hospital admissions. Interventions targeting this high-risk group may decrease frequent hospital readmissions and increase access to transplantation.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Alcohol / Ambulatory care / Biology / Chronic illnesses / Cirrhosis / Cohort Studies / Cultural differences / Demographics / Demography / Diabetes / Diabetes mellitus / Drug abuse / Ethnicity / Female / Gastroenterology / Health care expenditures / Heart failure / Hepatitis / Hepatology / Hospitalization / Humans / Liver / Liver cirrhosis / Liver Cirrhosis - therapy / Liver diseases / Liver transplantation / Liver Transplantation - statistics & numerical data / Liver transplants / Logistic Models / Male / Medical records / Medical research / Medicine / Middle Aged / Nutrition / Organ transplantation / Parenteral nutrition / Patient Readmission - statistics & numerical data / Patients / Public health / Race / Retrospective Studies / Risk analysis / Risk Factors / Risk groups / Social and Behavioral Sciences / Transplantation / Transplants & implants / Variables