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Short hospital length of stay linked to cirrhosis-related readmission

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PHILADELPHIA — The 30-day readmission rate among patients with cirrhosis was 55% in a recent study and was tied to short hospital length of stay, as presented at the American College of Gastroenterology Annual Meeting.

“Decompensated cirrhosis is one of the most common causes of hospital readmissions in the United States,” Chandraprakash Umapathy, MD, MS, from the University of California in San Francisco, said during his presentation. “One in every four patients with more than three complications of cirrhosis readmitted within 30 days and one-third readmitted within 90 days. We sought to determine the national readmission rates in cirrhosis and the causes and predictors of readmission.”

Among a cohort of 12,599 patients with cirrhosis, 55% readmitted within 30 days and 84% readmitted within 90 days.

Umapathy and colleagues found no significant difference in readmissions between patients with nonalcohol-related cirrhosis and alcohol-related cirrhosis. However, cirrhosis caused by alcohol was less likely to lead to readmission than nonalcohol-related cirrhosis (OR = 0.91).

Factors associated with an increased risk for readmission included weekend admission (OR = 1.17), hospital bed-size (big vs. small; OR = 1.12), transfer to other facilities including skilled nursing facilities (OR = 1.45) and discharge with home health care (OR = 1.26).

Complications associated with an increased risk for readmission included ascites (OR = 1.53), hepatic encephalopathy (OR = 1.1), and hepatorenal syndrome (OR = 1.72), whereas portal hypertension (OR = 0.87) and variceal bleeding (OR = 0.59) correlated with lower odds of readmission.

Additionally, private not-for-profit hospitals were less likely to have a readmission compared with government-owned hospitals (OR = 0.87).

“Focus on length of stay may result in patients being discharged prematurely, leading to high rates of early readmission,” Umapathy said. “Quality improvement efforts should focus on optimizing the management of complications of cirrhosis in the outpatient setting.” – by Talitha Bennett

Reference: Umapathy C. Abstract 60. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.

Disclosure: Umapathy reports no relevant financial disclosures.