30-Day Readmission Rates and Its Predictors in Post-Liver Transplantation Patients: Analysis of the Nationwide Readmission Database

Abstract

Introduction: Liver Transplantation (LT) is the only curative procedure for end-stage liver disease, yet it is complicated by a high 30 day readmission rate (30-50%). There have been many single center studies investigating the patient predictors and one-year mortality of patients requiring 30 day post-LT readmissions. While the rate of these readmissions has been similar, the predictors of readmission rate are varied. We aim to study the 30 day readmission rate, its predictors and mortality in post-LT patients. Methods: We performed a retrospective study, collecting data from the Nationwide Readmissions Database for the months of January to November of 2013 on all inpatients (18 years or older) with principal diagnosis of orthotopic LT (ICD-9 code 50.59). We excluded patients who died during the index admission and those with index admission duration of greater than or equal to 30 days. We then analyzed all of the readmissions within 30 days of discharge. We compared patient, hospital and clinical presentations (including Clavien and Elixhauser comorbidity indices) among groups with and without 30 day readmission. Finally, a multivariate logistic and linear regression models were fit. Results: In 2013, 4,588 patients underwent orthotopic LT; of these 1,429 (31%) were readmitted within 30 days. Patients who underwent LT at a small (OR:1.22; CI: 1.00-1.48) and medium (OR: 1.48; CI: 1.23-1.77) hospital bed size and belonging to low income (OR: 1.38; CI:1.08-1.77) have increased chances of 30 day readmission on multivariate analysis. Moreover, patients with ascites who underwent LT (OR:1.37; CI:1.16-1.62) have increased chances of readmission. 30 day and overall mortality post-LT was found to be 0.7% (n=32) and 1.4% (n=64), respectively. Most importantly, patients who were readmitted within 30 days have an increased overall mortality (44/64;69%) in one year as compared to those not readmitted (1385/4524; 31%), p=0.01. Conclusion: One third of patients were readmitted within 30 days after LT in 2013. Low income, admission in a small or medium size hospital and LT for patients with ascites contributed to 30 day readmissions. 30 day readmission leads to a higher risk of mortality within one year in these patients. Further research is required to identify the factors related to low income as well as small and medium sized hospitals that lead to 30 day readmissions.Table: Table. Multivariable logistic regression analysis of readmissions within 30 days of discharge from orthotopic liver transplantation