2016-04-19 20:25:45 UTC

10 Insights Into Why Patients with Cirrhosis Get Readmitted

April 19, 2016

CGH study offers insight into hospital readmission for cirrhosis patients and provides several important lessons for programs aimed at curbing readmissions.

A new, multistate population-based cohort study by Elliot B. Tapper, MD, and colleagues — published in Clinical Gastroenterology and Hepatology (CGH) as an article in press — provides insight into the rates of and reasons for readmission to the hospital among patients with cirrhosis.

Here are 10 insights offered by this research:

1. A high proportion of patients with cirrhosis are readmitted to the hospital (often to a different hospital) within 30 or 90 days.

2. The overall 30-day and 90-day readmission rates were 12.9 and 21.2 percent, rising to 24.2 and 35.9 percent for patients with multiple cirrhotic complications.

3. Encephalopathy is most strongly associated with readmission.

4. Almost one in every four readmissions was to a different hospital than the one from which the patient was discharged.

5. Among patients with alcoholic liver disease and a history of a complications of cirrhosis, the two most common reasons for readmission were acute complications of cirrhosis (in 41.7 percent) and substance abuse (in 25 percent).

6. Conversely, the most common reasons for readmission of patients with a history of complications of cirrhosis without alcoholic liver disease were acute complications (in 41 percent) and cancer complications (in 16.2 percent).

7. Programs aimed at curbing readmission should focus on intensified mental health resources for patients with alcoholic liver disease.

8. Patients with cirrhosis present with profoundly complex, often conflicting medical needs (e.g. diuretics for ascites in the setting of renal insufficiency or hyponatremia; anxiety treated with sedatives which may precipitate encephalopathy). Interventions are needed to maintain vigilance at the time of discharge with respect to medication reconciliation, diuretic dose selection and patient/family education.

9. Patients are somewhat frequently readmitted within 30-days of discharge with their first episode of ascites or hepatic encephalopathy. Accordingly, for patients with seemingly compensated cirrhosis, hospitalization is often a heralded event for an ensuing period of disability and vulnerability that demands close medical attention.

10. These data, together with those from the prior smaller studies, will prove important in the benchmarking of quality indicators, powering prospective clinical studies and highlighting areas for improvement.

For additional insights, read the full study on the CGH website (login required).

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