Thirty Day Readmission Rate for Patients Admitted With Spontaneous Bacterial Peritonitis

Abstract

Introduction: Spontaneous Bacterial Peritonitis (SBP) is a fairly common problem in hospitalized patients with liver cirrhosis. It is itself associated with prolonged hospitalization and significant morbidity and can also lead to complications like variceal bleeding and Hepatorenal syndrome with resultant high mortality. We aim to identify the rates for thirty day readmissions in cirrhotic patients admitted with SBP. Methods: We used the Nationwide Readmissions Database provided by Agency of Healthcare Research and Quality for year 2013. Primary diagnosis ICD-9 code 567.23 was used to identify index admissions for SBP. All the patients admitted within 30 days of Index admission were considered to be readmissions, as defined by Center for Medicare and Medicaid Services (CMS). All patients who died during their index admission, were not residents of that state, had missing information for key variables were excluded since they were not at risk of readmission. We also excluded the patients with index discharge in December 2013 since there was not enough time for a thirty-day readmission. Manufacturer provided sampling weights were used to produce national estimates. Readmission rate was calculated by dividing index admission with one or more readmissions over all index admissions. Results: There were 4382 eligible index hospitalizations for SBP in 2013, Mean age was 56.7 years, 66.9% males. 1526 of these had one or more thirty-day readmissions giving a readmission rate of 34.8%. Demographic characteristics, hospital characteristics and outcomes of both groups are described in Table 1. 9.3% of all thirty-day readmissions were primarily due to SBP. Other common primary diagnoses of the thirty-day readmissions were hepatic encephalopathy (9%), septicemia (5.3%), and acute kidney injury (3.4%). Readmission group had a longer median Length of stay (LOS) (6 vs 5 days).Mean cost of a readmission was $21864.Table: Table. Baseline Characteristics and OutcomesConclusion: Knowledge and understanding of the causes for readmission in SBP is important to identify avenues for intervention so that the morbidity and the costs associated with readmissions can be avoided. Some of the readmissions are likely unavoidable and point to progressively worsening liver disease. Since most readmissions were due to SBP, ensuring adequate antibiotic treatment with 3rd generation cephalosporins and Albumin when indicated for index admissions, as well as antibiotic prophylaxis on discharge as per AASLD guidelines might help prevent some of them.