Multivariate Analysis of Factors Contributing to Early Hospital Readmission After Liver Transplantation.

Abstract

Hospital readmission in the first 90 days following liver transplantation (LT) is a common problem among transplant centers. Early readmission following LT may correlate with decreased survival and significantly increase the cost associated with post-transplant care. In the current healthcare environment, transplant centers are increasingly scrutinized not only for survival but also for the financial burden of high-cost readmissions. There are few published studies examining risk factors associated with early readmission following LT and, for those few, the findings are inconsistent. The aim of this study was to examine possible risk factors associated with early hospital readmission after LT. The sample was assembled of adult LT recipients at a single center between 2005 and 2013. Those who were transplanted via the associated Veteran's Affairs program were excluded. Multivariate logistic regression was used to evaluate whether the likelihood of readmission within 30 and 90 days was related to recipient age, calculated MELD at LT, etiology of liver disease, hepatocellular carcinoma, history of portal vein thrombosis or abdominal surgery, previous LT, pretransplant hospitalizations, transplant year, and post-transplant length of stay (LOS). Additionally, the donor risk index (DRI) was calculated for each recipient's donor and was incorporated into the model. The sample included 564 recipients. Both recipient and donor characteristics are included in Table 1. Analyses demonstrated no independent effect of any covariates on the likelihood of readmission within 30 days. Increased LOS was associated with an increased likelihood of readmission within 90 days (p=0.014), with persons who were hospitalized for greater than 8 days being approximately 1.9 times more likely (p≤0.008) to be readmitted than those who were hospitalized for 8 days or less after LT.Table: No Caption available.In this multivariate analysis, there was no statistically significant effect of the covariates on the likelihood of readmission within 30 days. These findings suggest the complex interplay of not only these factors but also social, economic, and environmental factors that contribute to readmission.