Cirrhosis Hospital Readmission Is Mostly Not Preventable

Hospital readmissions due to cirrhosis are often not preventable, according to study findings published in The American Journal of Gastroenterology.

Patients with cirrhosis have an elevated risk for early hospital readmission, which increases costs and reduces overall quality of life. There is limited research regarding the prevention of hospital readmissions in this patient population.

Researchers conducted a prospective cohort study to evaluate the risk factors and incidence associated with preventable hospital readmissions among patients with cirrhosis.

Patients with cirrhosis who were hospitalized at Indiana University Hospital were enrolled in this study. The researchers collected data between June 2014 and March 2020 from patients aged 18 years and older diagnosed with cirrhosis.

Preventable readmission was defined as a hospital admission that could have been prevented by adequate quality of care in the initial hospitalization, sufficient discharge planning or postdischarge follow-up, or improved coordination of care. The degree of preventability was rated on a 5-point Likert scale.

The researchers categorized patients into 3 groups: alive without readmission, preventable readmission, or nonpreventable readmission or death. 

Of the 654 patients enrolled and discharged within the 30-day follow-up period, 246 (38%) patients were readmitted, 29 (12%) of which were considered preventable. Among patients requiring readmission, 36% went to a different hospital. 

After researchers reviewed the cases, they considered 9 cases preventable (31%) and 162 nonpreventable (75%). Cases where reviewers could not come to a consensus were considered nonpreventable.

The researchers reported a median time to preventable admission of 9 days (IQR, 5-21 days) and a median of 13 days for nonpreventable readmissions (IQR 7-21 days; P =.32).

The most common reasons for readmission were hepatic encephalopathy (22%), gastrointestinal bleeding (13%), acute kidney injury (13%), and ascites (6%).

The reasons for readmissions were not significantly different between the preventable and nonpreventable admission groups (P =.47); however, there was a greater prevalence of ascites in patients with preventable readmissions compared with nonpreventable (14% vs 5%, respectively). 

Some common potential reasons for readmissions include access to timely paracentesis (8 patients), monitoring after diuretic adjustment (7 patients), and ensuring an adequate supply and clear directions for hepatic encephalopathy medications (4 patients).

Within the 30-day follow-up period, 22 patients died, 2 of which were part of the preventable admission group. 

Patients with preventable readmissions were more likely to be in racial and ethnic minority groups compared with patients with nonpreventable readmission or no readmission (odds ratio [OR], 5.80; 95% CI, 1.96-17.13). In addition, patients with preventable readmissions had a greater likelihood of admission in the prior 30 days (OR, 3.45; 95% CI, 1.48-8.04).

“Reducing readmissions for patients with cirrhosis is a priority for the hepatology community, but there is a paucity of data supporting specific interventions for this problem,” study authors wrote. “This study lays the groundwork for future research by providing important data describing features of preventable readmissions that can be targeted in future intervention studies.”

Study limitations include lack of generalizability, a small number of racial and ethnic minorities included, and a small number of readmissions among the entire sample. 

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Gastroenterology Advisor