Early Hospital Readmissions and Mortality in Patients With Decompensated Cirrhosis Enrolled in a Large National Health Insurance Administrative Database

Scaglione, Steven; Metcalfe, Leanne; Kliethermes, Stephanie; Vasilyev, Ivan; Tsang, Rebecca; Caines, Allyce; Mumtaz, Shaham; Goyal, Vik; Khalid, Asra; Shoham, David A.; Markossian, Talar; Luke, Amy; Underwood, Howard R.; Cotler, Scott J.

doi:10.1097/mcg.0000000000000826

Cited by 51 publications

(72 citation statements)

References 19 publications

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“…The majority of patients were readmitted for a liver cirrhosis–related reason in our study, similar to others in the literature . Modifiable predictors of readmission previously reported are ascites, HE, and requirement for procedures such as paracentesis .…”

Section: Discussionsupporting

confidence: 88%

“…Between January and November 2011, 3.3 million adults were readmitted within 30 days of prior hospital discharge with an associated $41.3 billion in total hospitalization costs . Studies of patients with decompensated cirrhosis based on single‐center data, private employer–based health insurance claims data, and the NACSELD database have reported 30‐day readmission rates of 20%, 34%‐40%, and 53%, respectively . The 30‐day readmission rate in our study falls within the previously reported range.…”

Section: Discussionsupporting

confidence: 76%

“…NACSELD has reported a 3‐month readmission rate of 53%. Another study using a claims database of privately insured patients reported a 30‐day readmission rate of 34%‐40% over 5 years . In our study, 65.6% of patients were insured by Medicaid or Medicare and only 19.8% and 8.2% were privately insured or self‐paying, respectively.…”

Section: Discussionmentioning

confidence: 50%

“…Given the economic burden of hospital readmissions, the Patient Protection and Affordable Care Act instituted the Readmission Reduction Program that required the Centers for Medicare & Medicaid Services (CMS) to reduce payment for hospitals with higher readmission rates . Rates of readmission among patients with decompensated cirrhosis have been reported in various studies to be as high as 20%‐50% . A study based on private employer insurance analyzed over 16,000 patients with decompensated cirrhosis over 5 years and found that >50% of patients were readmitted within 30 days .…”

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confidence: 99%

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Validation of Risk Score in Predicting Early Readmissions in Decompensated Cirrhotic Patients: A Model Based on the Administrative Database

et al. 2019

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One third of patients with decompensated cirrhosis are readmitted within 30 days of discharge. The use of simple risk scoring model with high generalizability, based on demographics, clinical features and interventions can bring refinement to the prediction of 30-day readmission in high risk patients. Mumtaz readmission risk score highlights the need for targeted interventions in order to decrease rates of readmission within this population. This article is protected by copyright. All rights reserved.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 50%

mentioning

confidence: 99%

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Validation of Risk Score in Predicting Early Readmissions in Decompensated Cirrhotic Patients: A Model Based on the Administrative Database

et al. 2019

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“…Features of decompensated cirrhosis, including variceal bleeding, ascites and hepatic encephalopathy (HE), have a detrimental impact on patient quality of life and survival . Patients with decompensated cirrhosis require extensive ongoing healthcare .…”

Section: Introductionmentioning

confidence: 99%

Nationwide estimates and risk factors of hospital readmission in patients with cirrhosis in the United States

Shaheen

Nguyen

Congly

et al. 2019

Liver International

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Background The burden of cirrhosis on the healthcare system is substantial and growing. Our objectives were to estimate the readmission rates and hospitalization costs as well as to identify risk factors for 90‐day readmission in patients with cirrhosis. Methods We conducted a weighted analysis of the 2014 Nationwide Readmission Database to identify adult patients with cirrhosis‐related complications in the United States and assessed readmission rates at 30, 60 and 90 days post‐index hospitalization. Predictors of 90‐day readmissions were identified using weighted regression models adjusting for patient and hospital characteristics; the national estimate of hospitalization costs was also calculated. Results Of the 58 954 patients admitted with cirrhosis‐related complications in 2014, 14 910 (25%) were readmitted within 90 days because of cirrhosis‐related complications. The main causes of readmission were ascites (56%), hepatic encephalopathy (47%) and bleeding oesophageal varices (9%). Independent predictors of 90‐day readmissions were male sex (adjusted OR [aOR]: 1.08, 95% CI, 1.04‐1.13), age <60 (aOR: 1.27, 95% CI, 1.22‐1.32), privately insured (aOR: 0.74, 95% CI, 0.70‐0.77), having ≥3 comorbid conditions (aOR: 1.27, 95% CI, 1.14‐1.42) and being discharged against medical advice (aOR: 1.41, 95% CI, 1.25‐1.59). The weighted cumulative national cost estimate of the index admission was $1.8 billion, compared to $0.5 billion for readmission. Conclusions A quarter of patients admitted with cirrhosis‐related complications were readmitted within 90 days, representing a significant economic burden related to readmission of this population. Interventions and resource allocations to reduce readmission rates among cirrhotic patients is critical.

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Changing Trends in Etiology‐Based and Ethnicity‐Based Annual Mortality Rates of Cirrhosis and Hepatocellular Carcinoma in the United States

et al. 2019

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Cirrhosis- and HCC-related mortality rates increased between 2007 and 2016 in the US. However, mortality rates in HCV-cirrhosis demonstrated a significant decline from 2014-2016, during the direct-acting antiviral era. Mortality rates for ALD/NAFLD-cirrhosis and HCC have continued to increase, while HBV-cirrhosis-related mortality declined during the 10-year period. Importantly, minorities had a disproportionately higher burden of ESLD-related mortality. This article is protected by copyright. All rights reserved.

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Early Hospital Readmissions and Mortality in Patients With Decompensated Cirrhosis Enrolled in a Large National Health Insurance Administrative Database

Cited by 51 publications

References 19 publications

Validation of Risk Score in Predicting Early Readmissions in Decompensated Cirrhotic Patients: A Model Based on the Administrative Database

Validation of Risk Score in Predicting Early Readmissions in Decompensated Cirrhotic Patients: A Model Based on the Administrative Database

Nationwide estimates and risk factors of hospital readmission in patients with cirrhosis in the United States

Changing Trends in Etiology‐Based and Ethnicity‐Based Annual Mortality Rates of Cirrhosis and Hepatocellular Carcinoma in the United States

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