Am J Gastroenterol. 2023 Aug 7. doi: 10.14309/ajg.0000000000002455. Online ahead of print.
OBJECTIVES: Hospital readmissions are common in cirrhosis, but there are few studies describing readmission preventability. We aimed to describe the incidence, causes, and risk factors for preventable readmission in this population.
METHODS: We performed a prospective cohort study of patients with cirrhosis hospitalized at a single center between June 2014 and March 2020 and followed for 30 days post-discharge. Demographic, clinical, and socioeconomic data, functional status, and quality of life were collected. Readmission preventability was independently and systematically adjudicated by 3 reviewers. Multinomial logistic regression was used to compare those with (1) preventable readmission, (2) non-preventable/death, and (3) no readmission.
RESULTS: Of 654 patients, 246 (38%) were readmitted, and 29 (12%) were preventable. Reviewers agreed on preventability for 70% of readmissions. Twenty-two (including 2 with preventable readmission) died. The most common reasons for readmission were hepatic encephalopathy (22%), gastrointestinal bleeding (13%), acute kidney injury (13%), and ascites (6%), and these reasons were similar between preventable and non-preventable readmissions. Preventable readmission was often related to paracentesis timeliness, diuretic adjustment monitoring, and hepatic encephalopathy treatment. Compared to non-readmitted patients, preventable readmission was independently associated with racial and ethnic minoritized individuals (OR 5.80; 95% CI, 1.96-17.13), non-married marital status (OR 2.88; 95% CI, 1.18-7.05), and admission in the prior 30 days (OR 3.45; 95% CI, 1.48-8.04).
CONCLUSIONS: For patients with cirrhosis, readmission is common, but most are not preventable. Preventable readmissions are often related to ascites and hepatic encephalopathy and are associated with racial and ethnic minorities, non-married status, and prior admissions.