Introduction: The care provided for patients with decompensated cirrhosis is highly variable and associated with high 30 day readmission rates.
Methods: We conducted a single center retrospective analysis reviewing 30 day readmission rates for adults admitted for decompensated cirrhosis between 01/01/2018 and 12/31/2020. The severity of patients’ cirrhosis was evaluated utilizing Na-MELD scoring. Patient demographics, etiology of cirrhosis, decompensating event, and outpatient primary care provider (PCP) follow-up were evaluated as possible risk factors for readmission.
Descriptive statistics are presented as percentages. Chi-square or Fisher exact tests were used to analyze differences between groups for categorical variables. P-values are 2-sided, and statistical significance was defined as p-value < .05. Analyses were performed using SAS software, version 9.4.
Results: A total of 2,205 patient encounters were reviewed with 423 (19%) readmitted within 30 days of discharge. On average, these patients were readmitted within 12.3 days. The average Na-MELD score was 18.3 ± 7.1. Patients were primarily male (57%), Caucasian (83%), and had Medicare or Medicaid (70%). The age groups with the highest 30 day readmission rates were those 36-50 n=101 (23%) and 51-65 n=170 (22%), p-value .0007. Compared to patients who did not have alcoholic cirrhosis, patients who had alcoholic cirrhosis were significantly more likely to be readmitted within 30 days n=182 (23%) vs n=241 (17%), p-value .0003. The 30 day readmission rate was higher in those with ascites n=140 (25%) vs without ascites n=283 (17%), p-value .0001, and with hepatic encephalopathy n=76 (23%) vs without hepatic encephalopathy n=347 (18%), p-value .0344. In cases of spontaneous bacterial peritonitis (SBP) the 30 day readmission rate was n=140 (25%) vs n=283 (17%) without SBP, p-value .0238. In cases where a PCP evaluated the patient within 30 days after discharge (29%) the readmission rate decreased from n=324 (21%) down to n=99 (15%), p-value .0025.
Discussion: Our study illustrates the statistically significant increase in 30 day readmission rates in patients with cirrhosis associated with alcohol, ascites, SBP and hepatic encephalopathy. Short interval outpatient follow-up with a PCP also significantly reduces 30 day readmission demonstrating the importance of collaboration between inpatient and outpatient providers.
