Nonpreventable readmission prevalent in patients with cirrhosis

Readmissions within 30 days are common among patients with cirrhosis, but most of these are not preventable, reveals a study.

“Preventable readmissions are often related to ascites and hepatic encephalopathy and are associated with racial and ethnic minorities, nonmarried status, and prior admissions,” according to the investigators.

This cohort study included patients with cirrhosis hospitalized at a single centre between June 2014 and March 2020 and followed-up for 30 days following discharge. Demographic, clinical, and socioeconomic data, as well as information on functional status and quality of life, were gathered.

Three reviewers systematically and independently adjudicated readmission preventability. The investigators then used multinomial logistic regression to compare patients with preventable readmission, nonpreventable readmission or death, and no readmission.

In total, 654 patients with cirrhosis were included, of whom 246 (38 percent) had readmissions, and 29 (12 percent) had preventable readmissions. Of the readmission, 70 percent were preventable as per the reviewers. Twenty-two patients died, included two with preventable readmission.

Hepatic encephalopathy (22 percent) was the most common reason for readmission, followed by gastrointestinal bleeding (13 percent), acute kidney injury (13 percent), and ascites (6 percent). These reasons were similar between preventable and nonpreventable readmissions.

In addition, paracentesis timeliness, diuretic adjustment monitoring, and hepatic encephalopathy treatment were all related to preventable readmission.

Compared with no readmission, preventable readmission independently correlated with racial and ethnic minority (odds ratio [OR], 5.80, 95 percent confidence interval [CI], 1.96‒17.13), nonmarried marital status (OR, 2.88, 95 percent CI, 1.18‒7.05), and admission in the prior 30 days (OR, 3.45, 95 percent CI, 1.48‒8.04).