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

Shaheen, Abdel‐Aziz; Nguyen, Henry; Congly, Stephen E.; Kaplan, Gilaad G.; Swain, Mark G.

doi:10.1111/liv.14054

Cited by 49 publications

(39 citation statements)

References 32 publications

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“…However, our research involved a population‐based study that captured all readmissions within the health care system. A previous study in the United States, which conducted a weighted analysis of the 2014 Nationwide Readmissions Database, reported a readmission rate of 15%, and the main causes of readmission were complications of cirrhosis . Likewise, our data support that cirrhosis is a major economic burden in the health care system, because after initial admission most patients are readmitted again in the health care system.…”

Section: Discussionsupporting

confidence: 78%

Thirty‐Day Readmission and Cost Analysis in Patients With Cirrhosis: A Nationwide Population‐Based Data

Chirapongsathorn

Poovorawan²,

Soonthornworasiri³

et al. 2020

Hepatol Commun

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Accurate population‐based data are needed on the rate, economic impact, and the long‐term outcomes of readmission among patients with cirrhosis. To examine the rates, costs, and 1‐year outcomes of patients readmitted within 30 days following their index hospitalization for complications of cirrhosis, we conducted a nationwide, population‐based cohort study involving all patients with cirrhosis in Thailand from 2009 through 2013, using data from the National Health Security Office databases, which included those from nationwide hospitalizations. Readmission was captured from hospitals at all health care levels across the country within the Universal Coverage Scheme. For the 134,038 patients hospitalized with cirrhosis, the overall 30‐day readmission rate was 17%. Common causes of readmission consisted of complications of portal hypertension (47%) and infections (17%). After adjusting for multiple covariates, predictors of 30‐day readmission included hepatocellular carcinoma (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.84‐2.06), human immunodeficiency virus–related admission (OR 1.81, 95% CI 1.51‐2.17) and cholangiocarcinoma (OR 1.64, 95% CI 1.3‐2.05). In all, 2,936 deaths (13%) occurred during readmission, and an additional 14,425 deaths up to 1 year (63.5% total mortality among readmitted patients). Causes of death were mostly from liver‐related mortality. Average cost at index admission for those with a 30‐day readmission were significantly higher than those readmitted beyond 30 days or not readmitted. Conclusions: Patients hospitalized with cirrhosis complications had high rates of unscheduled 30‐day readmission. Average hospitalization costs were high, and only 36.5% of patients readmitted within 30 days survived at 1 year.

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Section: Discussionsupporting

confidence: 78%

Thirty‐Day Readmission and Cost Analysis in Patients With Cirrhosis: A Nationwide Population‐Based Data

Chirapongsathorn

Poovorawan²,

Soonthornworasiri³

et al. 2020

Hepatol Commun

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“…In addition, inability to identify re‐admissions is one of the limitations of NIS dataset. A recent study utilizing the Nationwide Readmission Database reported that 25% of patients with cirrhosis are re‐admitted with liver‐related complication within 90 days . Therefore, our results are limited by the fact that we were unable to exclude patients who were re‐admitted.…”

Section: Discussionmentioning

confidence: 95%

“…A recent study utilizing the Nationwide Readmission Database reported that 25% of patients with cirrhosis are re-admitted with liver-related complication within 90 days. 29 Therefore, our results are limited by the fact that we were unable to exclude patients who were re-admitted. Since the cause of in-hospital mortality was not available in the NIS database, we are unable to Abbreviations: CI, confidence interval; NAFLD, non-alcoholic fatty liver disease; OR, odds ratio.…”

Section: Discussionmentioning

confidence: 96%

Trends in hospitalizations for chronic liver disease‐related liver failure in the United States, 2005‐2014

Kim

Cholankeril

et al. 2019

Liver International

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Background & Aims Current estimates of the population‐based disease burden of liver failure or end‐stage liver disease (ESLD) are lacking. We investigated recent trends in hospitalizations and in‐hospital mortality among patients with ESLD in the United States (US). Methods A retrospective analysis was performed utilizing the National Inpatient Sample from 2005 to 2014. We defined ESLD as either decompensated cirrhosis or hepatocellular carcinoma (HCC), criteria obtained from the International Classification of Diseases, Ninth Revision. Nationwide rates of hospitalization and in‐hospital mortality were analysed from 2005 to 2014. Results Hospitalization rates for decompensated cirrhosis during this period increased from 105.3/100 000 persons to 159.9/100 000 persons. In terms of HCC, hospitalization rates increased from 13.6/100 000 to 22.1/100 000. In patients with non‐alcoholic fatty liver disease (NAFLD)‐related decompensated cirrhosis, the hospitalization rate increased from 13.4/100 000 to 32.1/100 000 with an annual incremental increase of 10.6%, a magnitude twofold higher than other aetiologies. The proportion of NAFLD among hospitalizations with ESLD steadily increased from 12.7% to 20.1% for decompensated cirrhosis while the proportion of chronic hepatitis C (HCV) and alcoholic liver disease (ALD) declined (from 29.3% to 27.6% for HCV; from 39.0% to 37.4% for ALD). Although the overall in‐hospital mortality rates for ESLD declined during the study, mortality rates for NAFLD‐related decompensated cirrhosis showed no significant change. Conclusions Among aetiologies of chronic liver disease, NAFLD demonstrated the fastest growing rate of hospitalizations in non‐HCC patients with ESLD in the US. Our study highlights the need for a focus on NAFLD‐related hospitalizations and its impact on resource utilization.

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“…90‐day transition percentages for staying alive without admission/LT was 50%, 4% for LT, 3% for death and 40% for admissions (range 25%‐60%). The estimate for hospitalisations was made from an admixture of several studies in outpatients and inpatients …”

Section: Methodsmentioning

confidence: 99%

“…Patients with cirrhosis have a complicated natural history characterised by admissions and readmissions over time . These admissions and readmissions in cirrhosis are prevalent and are a major cause of healthcare expenditure . However, prediction models using clinical biomarkers alone are largely suboptimal, with relatively low c‐statistics in population‐based and cohort studies .…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of integrating gut microbiota analysis into hospitalisation prediction in cirrhosis

et al. 2020

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Summary Background Admissions in cirrhosis are expensive and often unpredictable based on purely clinical variables. Admissions could be related to complications associated with gut microbial changes, which can improve prognostication. However, the cost‐effectiveness remains unclear. Aims Determine cost‐effectiveness of adding gut microbiota analysis to clinical parameters in prediction and subsequent reduction of admissions in cirrhosis. Methods Using a Markov model of 1000 cirrhosis patients over 90 days, we modelled microbiota testing using 16srRNA ($250/sample), low‐depth ($350/sample) and high‐depth ($650/sample) metagenomics added to standard‐of‐care (SOC) for prevention of admissions using standard outcome costs and rates of development. We generated quality of life years (QALY) and Incremental cost‐effectiveness ratios (ICER) for the base scenarios and performed sensitivity analyses by varying costs for outcomes (transplant, death, admission) and admission rates (40%, range 25%‐60%). Results Using fixed costs of outcomes and outcome rates, microbiota analysis was cost‐saving ($47K‐$97K) at $250 and $350/sample if admissions were reduced by 5% over SOC and >10% with $650/sample. When costs of liver transplant, death and admissions were varied, these cost‐savings remained robust provided there was >2.1% reduction (range 1.3%‐3.2%) for $250/sample, >2.9% (range 1.8%‐4.4%) for $350/sample and >5.4% (range 3.3%‐8.2%) for $650/sample. These cost‐savings remained robust even when the assumed admission rate was varied for all sample cost values. Conclusions Gut microbiota analysis is cost‐effective for predicting and potentially preventing 90‐day admissions in cirrhosis over current SOC. This cost‐saving remained robust even after sensitivity analyses that varied the background admission rates.

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

Cited by 49 publications

References 32 publications

Thirty‐Day Readmission and Cost Analysis in Patients With Cirrhosis: A Nationwide Population‐Based Data

Thirty‐Day Readmission and Cost Analysis in Patients With Cirrhosis: A Nationwide Population‐Based Data

Trends in hospitalizations for chronic liver disease‐related liver failure in the United States, 2005‐2014

Cost‐effectiveness of integrating gut microbiota analysis into hospitalisation prediction in cirrhosis

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