Abstract
Reduction of early hospital readmissions is a declared goal in the United States economic and quality improvement agenda. A retrospective study was performed using the Nationwide Readmissions Database from 2010 to 2014. Our primary aim was to study the rate of early readmissions and its predictors in liver transplant recipients (LTRs). Our secondary aims were to determine the trends of LT, reasons for readmission, costs and predictors of calendar year mortality. Multivariable logistic regression and Cox proportional hazards models were utilized. The 30-day readmission rate was 30.6% among a total of 25,054 LTRs. Trends of LT were observed to be increased in patients > 65 years (11.7–17.8%, p < 0.001) and decreased in 40–64 years (78.0–73.5%, p = 0.001) during study period. The majority of 30-day readmissions were due to post transplant complications, with packed red blood cell transfusions being the most common intervention during readmission. Medicaid or Medicare insurance, surgery at low and medium volume centers, infections, hemodialysis, liver biopsy, and length of stay > 10 days were the predictors of 30-day readmission. Moreover, number of early readmission, age > 64 years, non-alcoholic cirrhosis, and length of stay > 10 days were significant predictor of calendar year mortality in LTRs. Approximately one third of patients require early admission after LT. Early readmission not only increases burden on healthcare, but is also associated with calendar year mortality. Strategies should be implemented to reduce readmission in patients with high risk of readmission identified in our study.
Highlights
Reduction of early hospital readmissions is a declared goal in the United States economic and quality improvement agenda
We aimed to study the reasons for readmission as well as the impact of early readmission on calendar year mortality and healthcare resource utilization
The majority of patients underwent liver transplantation (LT) for non-alcoholic liver disease (75%; n = 18,715); ascites and HCC were reported for 48.2% (n = 12,072) and 33.4% (n = 8373) of patients, respectively
Summary
Reduction of early hospital readmissions is a declared goal in the United States economic and quality improvement agenda. Our primary aim was to study the rate of early readmissions and its predictors in liver transplant recipients (LTRs). The 30-day readmission rate was 30.6% among a total of 25,054 LTRs. Trends of LT were observed to be increased in patients > 65 years (11.7–17.8%, p < 0.001) and decreased in 40–64 years (78.0–73.5%, p = 0.001) during study period. The Affordable Care Act (ACA) mandated the public reporting of 30-day hospital readmission rates for several medical and surgical conditions. This step is a necessary precursor for the implementation of penalties (up to 3% reduction in reimbursements) to hospitals with elevated readmission rates[8]. We aimed to study the reasons for readmission as well as the impact of early readmission on calendar year mortality and healthcare resource utilization
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