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Same- vs Different-Hospital Readmissions in Patients With Cirrhosis After Hospital Discharge

Okafor, Philip N., MD, MPH1; Nnadi, Augustine K., MD, MPH2; Okoli, Okwuchukwu, MD3; Huang, Alice E., BS4; Nwaiwu, Obioma, MD, PhD5

American Journal of Gastroenterology: March 2019 - Volume 114 - Issue 3 - p 464–471
doi: 10.14309/ajg.0000000000000050
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INTRODUCTION: There is a lack of data on the impact of readmission to the same vs a different hospital following an index hospital discharge in cirrhosis patients.

METHODS: We sought to describe rates and predictors of different-hospital readmissions (DHRs) among patients with cirrhosis and also determine the impact on cirrhosis outcomes including all-cause inpatient mortality and hospital costs. Using the national readmissions database, we identified cirrhosis hospitalizations in 2013. Regression analysis was used to determine the predictors of DHRs. A time-to-event analysis was performed to assess the impact on subsequent readmissions and all-cause inpatient mortality.

RESULTS: In 2013, there were 109,039 cirrhosis readmissions with 67% of these being same-hospital readmissions and 33% being DHRs (P < 0.001). Two percent of readmitted patients were treated at ≥4 different hospitals. The 30-day readmission rate was 29.1%. Predictors of DHR included Medicaid payer (adjusted odds ratio [OR] 1.07, 95% confidence interval [95% CI] 1.01–1.14), age (OR 0.98, 95% CI 0.978–0.982), elective admission (OR 1.09, 95% CI 1.01–1.17), hepatic encephalopathy (OR 1.20, 95% CI 1.16–1.25), hepatorenal syndrome (OR 1.09, 95% CI 1.03–1.16), and low socioeconomic status (OR 1.15, 95% CI 1.06–1.25). No difference was observed in 30-day readmission risk following a DHR (adjusted hazard ratio 1.044, 95% CI 0.975–1.118). In addition, there was no increased risk of inpatient death observed during a DHR within 30 days (adjusted hazard ratio 1.08, 95% CI 0.94–1.23). However, patients with DHR had significantly higher hospital costs and length of stay.

CONCLUSIONS: Majority of cirrhosis readmissions are same-hospital readmissions. Different-hospital readmissions do not increase the risk of 30-day readmissions and inpatient mortality but are associated with higher hospital costs.

1Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA;

2Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana, USA;

3Department of Internal Medicine, Good Shepard Medical Center/University of Texas Health Science Center, Tyler, Texas, USA;

4Mayo Clinic School of Medicine, Rochester, Minnesota, USA;

5Department of Family & Preventive Medicine, University of Arkansas School of Medical Sciences, Little Rock, Arkansas, USA.

Correspondence: Philip N. Okafor, MD, MPH. E-mail: pokafor@stanford.edu.

Oral presentation at the Digestive Disease Week, Chicago, Illinois, USA, May 2017.

Received June 21, 2018

Accepted November 05, 2018

© The American College of Gastroenterology 2019. All Rights Reserved.
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