Paracentesis in cirrhotics is associated with increased risk of 30-day readmission

ARTICLE HIGHLIGHTS

Research background

Patients with decompensated cirrhosis secondary to ascites or hepatic encephalopathy are at high risk of complication and readmission. Previous studies have determined that performing a paracentesis in these patients will improve inpatient mortality; however, the effect of performing a paracentesis on 30-d readmission has not been studied.

Research motivation

Given the economic burden of readmissions, we aimed to determine the readmission rate in patients with decompensated cirrhosis with ascites and encephalopathy. Identifying factors associated with readmission are crucial to preventing unnecessary hospital admission and healthcare spending.

Research objective

The objective for this study included determining 30-d readmission rate in patients with cirrhosis with ascites or encephalopathy, reasons for readmission, factors associated with readmission and cost of readmission.

Research methods

We performed a retrospective database analysis utilizing the Nationwide Readmission Database. All adult patients with a diagnosis of cirrhosis and ascites or encephalopathy were included. Multivariate analysis was performed to assess predictors of 30-d readmission and cost of readmission.

Research results

The 30 d readmission rate in patients with cirrhosis and ascites or encephalopathy was 31% and the majority of patients were readmitted for liver related issues (58%). Paracentesis was performed on 50% of patients during the index admission. Factors associated with readmission included age under 64, Medicaid or Medicare insurance provider, greater than 3 Elixhauser comorbidities, nonalcoholic cirrhosis, hepatocellular carcinoma and undergoing a paracentesis on index admission. Cost of index admission between patients that were readmitted within 30 d and those that were not readmitted were similar; however cost of care was significantly higher for the readmission compared to the index admission.

Research conclusion

This study determined the readmission rate and economic burden of 30-d readmission in patient with cirrhosis and ascites or encephalopathy. We also highlighted multiple factors associated with readmission, specifically undergoing a paracentesis that were associated with 30 d readmission. Modifying factors associated with readmission during index admission could reduce unplanned readmissions, decrease the economic burden associated with readmission and decrease patient morbidity and mortality.

Research perspectives

Further directions for this research include implementing intervention to modify factors associated with readmission in order to determine the effect on readmission, cost and patient mortality.