Hospitals with the highest readmission rates for high-cost conditions may be targeted for payment penalties. The primary aim of this study was to determine clinical predictors of 30-day readmission after discharge for patients undergoing orthotopic liver transplantation (OLT) at the University of Washington from January 2003 to October 2010. Secondary aims included the determination of predictors of institutional care after OLT and differences in survival between patients requiring 30-day readmission and patients not requiring 30-day readmission. Sixty-five of 766 discharged OLT patients (8.6%) required institutional care on discharge; 318 of the 701 remaining patients (45%) were readmitted within 30 days. The predictors of readmission included hospitalization within the 90 days before OLT [29.6% versus 18.4%, relative risk (RR) ¼ 1.33, P ¼ 0.04], pre-OLT portal vein thrombosis (7.9% versus 4.4%, RR ¼ 1.76, P ¼ 0.01), a creatinine level > 1.9 mg/dL (23.9% versus 11.5%, RR ¼ 2.1, P 0.01), an albumin level < 2.6 mg/dL (51.9% versus 37.6%, RR ¼ 1.57, P < 0.01), postoperative complications (38.7% versus 30.2%, RR ¼ 1.31, P ¼ 0.04), and a high school education or less (14.5% versus 10%, RR ¼ 1.41, P ¼ 0.04). One year after OLT, decreased survival was found for patients requiring 30-day readmission versus patients not requiring readmission (88.2% versus 95.6%, P < 0.05). In conclusion, this study has identified patients at high risk of readmission who may benefit from medical optimization. Liver Transpl 18:1037-1045, 2012. See Editorial on Page 1007Hospital readmissions are a leading topic of health care policy and practice reform, and they are increasingly being viewed as a clinical outcome measure. With an estimated cost to Medicare of 17.4 billion dollars in 2004, hospital readmissions are a large target for cost reduction. The Medicare Affordable Care Act of 2010 directs the Centers for Medicaid and Medicare Services to track hospital readmission rates for certain high-cost conditions and implement a payment penalty for hospitals with the highest readmission rates. 1 A readmission is defined as a return to the same hospital or a different hospital for the same condition within a time frame to be specified by the Secretary of Health and Human Services. The use of readmission rates as a measure of quality has implications that extend beyond financial concerns and could potentially affect referral patterns, medical education, and credentialing. Several measures that aim to decrease readmission rates may result in an increased initial hospital length of stay (LOS), and the cost-effectiveness of this strategy remains unclear.Orthotopic liver transplantation (OLT) is an expensive procedure with estimated US annual costs greater than 3 billion dollars and a per-patient cost greater than half a million dollars for the first year after OLT. 2 The postdischarge requirements of some OLT recipients for inpatient rehabilitation and skilled nursing facilities further increase expenditures and the utilization of resources. At t...

Measurement of arterial ammonia has been used as a diagnostic test for hepatic encephalopathy, but obtaining an arterial specimen is an invasive procedure. The aim of this study was to evaluate the ability of a minimally invasive, highly sensitive optical sensing device to detect ammonia in the breath of patients with end-stage liver disease and to evaluate the correlation of breath ammonia levels, arterial ammonia levels, and psychometric testing. Fifteen subjects with liver cirrhosis and clinical evidence of hepatic encephalopathy underwent mini-mental status examination, number connection test, focused neurological examination, and arterial ammonia testing. On the same day, breath ammonia testing was performed using an apparatus that consists of a sensor (a thin membrane embedded with a pH-sensitive dye) attached to a fiberoptic apparatus that detects optical absorption. Helicobacter pylori testing was performed using the 14C urea breath test. A positive correlation was found between arterial ammonia level and time to complete the number connection test (r = 0.31, P = 0.03). However, a negative correlation was found between breath ammonia level and number connection testing (r = -0.55, P = 0.03). Furthermore, no correlation was found between breath and arterial ammonia levels (r = -0.005, P = 0.98). There is a significant correlation between the trailmaking test and arterial ammonia levels in patients with cirrhosis. However, no correlation was found between breath and arterial ammonia levels using the fiberoptic ammonia sensor apparatus in this small study.

Previous studies examining the relationship between HFE mutations and severity of nonalcoholic steatohepatitis (NASH) have been limited by small sample size or ascertainment bias. The aim of this study was to examine the relationship between HFE mutations and histological severity in a large North American multicenter cohort with NASH. Data from 126 NASH patients were collected from 6 North American centers. Liver biopsy and genotyping for the C282Y and H63D HFE mutations were performed in all subjects. Serum transferriniron saturation and ferritin levels as well as hepatic iron content were recorded whenever available. Univariate and multivariate logistic regression analyses were performed to identify factors associated with advanced hepatic fibrosis.

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