Etiology, Model for End-Stage Liver Disease and Hospitalization Requiring Intensive Care are Predictors of 30-day Readmission in Patients with Liver Disease

Abstract

Purpose: Preventable hospital readmissions is an important issue in health care policy, and practice reform is vital to reducing cost, and improving quality of care. This study attempts to identify inpatient process issues as well as disease specific risk factors which may predispose a patient with liver disease to 30-readmission. Methods: Patients admitted to the liver service between August 2008 and September 2010 in patients with chronic liver disease were considered for the study. Patients were excluded if they had an admission within 30 days of the index admission and should have had at least one outpatient clinic visit during the time to follow-up. All outpatient and inpatient encounters were tracked until either 1) death, 2) loss to follow-up, 3) liver transplantation, or 4) end of study period (31st, May 2012). Retrospective chart review of demographics, disease severity, complications, medication history, admission testing and treatment, follow-up and compliance to follow-up, as well as readmission data were collected. Descriptive statistics were computed for all factors. A time-to-readmission analysis was performed to assess factors associated with read-mission within 30 days; An automated stepwise variable selection method performed on 1000 bootstrap samples was used to choose the final multivariable model; A P < 0.05 was considered statistically significant. Results: A total of 306 patients were included in the analysis. Fifty-two percent were male and mean age on admission was 54.4 ± 11.0 years; 27.8% had a readmission within 30 days of being discharged. After adjusting for all variables in the multivariate model, HCV (p=0.006), ICU admission (p=0.007) and higher MELD at discharge (p=0.007) were found to be significantly associated with higher likelihood of readmission. Liver transplant (p=0.004) was more common in subjects who were readmitted within 30 days although mortality was not significant (p=0.26). Four percent of subjects died within 3 months of first discharge. Conclusion: More than one-fourth of patients hospitalized for liver disease get readmitted within a month, Subjects with HCV were 2.5 times more likely to be readmitted within 30 days than those without HCV. Subjects who required ICU admission during their hospital stay had almost 3 times higher odds of readmission than those who were not in the ICU. For every 1 unit increase in MELD score at time of discharge, the likelihood of being readmitted within 30 days increases by 8%. These criteria can be used to identify patients at highest risk for readmission that may benefit from aggressive discharge and transition of care planning.