Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2017; 23(37): 6868-6876
Published online Oct 7, 2017. doi: 10.3748/wjg.v23.i37.6868
Hospital readmissions in decompensated cirrhotics: Factors pointing toward a prevention strategy
Siamak M Seraj, Emily J Campbell, Sarah K Argyropoulos, Kara Wegermann, Raymond T Chung, James M Richter
Siamak M Seraj, Emily J Campbell, Sarah K Argyropoulos, Raymond T Chung, James M Richter, Massachusetts General Hospital, Division of Gastroenterology, Boston, MA 02114, United States
Kara Wegermann, Duke University Hospital, Department of Medicine, Durham, NC 27710, United States
Raymond T Chung, James M Richter, Harvard Medical School, Boston, MA 02115, United States
Author contributions: Seraj SM, Campbell EJ and Richter JM made substantial contributions to conception and design of study, acquisition of data, analysis and interpretation of data; Seraj SM, Campbell EJ, Argyropoulos SK, Wegermann K, Chung RT and Richter JM all contributed equally to the drafting the article or making critical revisions related to important intellectual content of the manuscript as well as gave final approval of the version of the article to be published.
Institutional review board statement: The study was reviewed and approved by the Partners Human Research Committee Institutional Review Board.
Informed consent statement: This study received an informed consent waiver from our Institutional Review Board due to minimal risk to study subjects.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: James M Richter, MD, MA, Director of Quality Management, Gastroenterology Division, Massachusetts General Hospital, 55 Fruit Street, Blake 4, Boston, MA 02114, United States.
Telephone: +1-61-77267595 Fax: +1-61-77260040
Received: November 29, 2016
Peer-review started: November 29, 2016
First decision: February 9, 2017
Revised: February 24, 2017
Accepted: March 30, 2017
Article in press: March 31, 2017
Published online: October 7, 2017

To reduce readmissions and improve patient outcomes in cirrhotic patients through better understanding of readmission predictors.


We performed a single-center retrospective study of patients admitted with decompensated cirrhosis from January 1, 2011 to December 31, 2013 (n = 222). Primary outcomes were time to first readmission and 30-d readmission rate due to complications of cirrhosis. Clinical and demographic data were collected to help describe predictors of readmission, along with care coordination measures such as post-discharge status and outpatient follow-up. Univariate and multivariate analyses were performed to describe variables associated with readmission.


One hundred thirty-two patients (59.4%) were readmitted at least once during the study period. Median time to first and second readmissions were 54 and 93 d, respectively. Thirty and 90-d readmission rates were 20.7 and 30.1 percent, respectively. Predictors of 30-d readmission included education level, hepatic encephalopathy at index, ALT more than upper normal limit and Medicare coverage. There were no statistically significant differences in readmission rates when stratified by discharge disposition, outpatient follow-up provider or time to first outpatient visit.


Readmissions are challenging aspect of care for cirrhotic patients and risk continues beyond 30 d. More initiatives are needed to develop enhanced, longitudinal post-discharge systems.

Keywords: Chronic disease, Re-hospitalizations, Liver disease, Readmissions, Cirrhosis, Chronic care

Core tip: To reduce readmissions and improve patient outcomes, we conducted a retrospective cohort study of 222 decompensated cirrhotics admitted to a single institution and followed longitudinally for readmission. Nearly 60% were readmitted during the study, with hepatic encephalopathy as the most common cause of readmission, with social factors, education level and insurance, also affecting readmission rates. We also found that readmission risk in this population continues well beyond 30 d, with 30% of patients being readmitted at 90 d, calling for continued, coordinated care after hospitalization.