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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Paracentesis in cirrhotics is associated with increased risk of 30-day readmission
Lindsay A Sobotka, Rohan M Modi, Akshay Vijayaraman, A James Hanje, Anthony J Michaels, Lanla F Conteh, Alice Hinton, Ashraf El-Hinnawi, Khalid Mumtaz
Lindsay A Sobotka, Rohan M Modi, Akshay Vijayaraman, Department of Internal Medicine, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
A James Hanje, Anthony J Michaels, Lanla F Conteh, Khalid Mumtaz, Division of Gastroenterology, Hepatology and Nutrition, the Ohio State Wexner Medical Center, Columbus, OH 43210, United States
Alice Hinton, Division of Biostatistics, College of Public Health, the Ohio State University, Columbus, OH 43210, United States
Ashraf El-Hinnawi, Department of Surgery, the Ohio State Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: Sobotka LA, Modi RM, Vijayaraman A and Mumtaz K analyzed the data, drafted the manuscript and revised for important intellectual content; Hinton A performed the statistical analysis; Hanje AJ, Michaels AJ, Conteh LF and El-Hinnawi A revised for important intellectual content; Mumtaz K supervised the study.
Institutional review board statement: The Ohio State University Data and Specimen Policy and Human Subjects Research Policy do not require Institutional Board Review approval for population-based public data sets. Per 45 Code of Federal Regulations (CFR 46.101), research using certain publicly available data sets does not involve “human subjects.”
Informed consent statement: The Ohio State University Data and Specimen Policy and Human Subjects Research Policy do not require informed consent for research conducted using publicy available data set as they do not involve “human subject.”
Conflict-of-interest statement: None of the authors have conflicts of interest.
Data sharing statement: No additional data is 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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Khalid Mumtaz, MD, MSc, Assistant Professor, Doctor, Division of Gastroenterology, Hepatology and Nutrition, the Ohio State Wexner Medical Center, 95 West 12
th Avenue, 2
nd Floor, Columbus, OH 43210, United States.
khalid.mumtaz@osumc.edu
Telephone: +1-614-2931456 Fax: +1-614-2936720
Received: December 22, 2018
Peer-review started: December 22, 2018
First decision: March 8, 2018
Revised: March 13, 2018
Accepted: April 11, 2018
Article in press: April 11, 2018
Published online: June 27, 2018
Processing time: 132 Days and 4.2 Hours
AIM
To determine the readmission rate, its reasons, predictors, and cost of 30-d readmission in patients with cirrhosis and ascites.
METHODS
A retrospective analysis of the nationwide readmission database (NRD) was performed during the calendar year 2013. All adults cirrhotics with a diagnosis of ascites, spontaneous bacterial peritonitis, or hepatic encephalopathy were identified by ICD-9 codes. Multivariate analysis was performed to assess predictors of 30-d readmission and cost of readmission.
RESULTS
Of the 59597 patients included in this study, 18319 (31%) were readmitted within 30 d. Majority (58%) of readmissions were for liver related reasons. Paracentesis was performed in 29832 (50%) patients on index admission. Independent predictors of 30-d readmission included age < 40 (OR: 1.39; CI: 1.19-1.64), age 40-64 (OR: 1.19; CI: 1.09-1.30), Medicaid (OR: 1.21; CI: 1.04-1.41) and Medicare coverage (OR: 1.13; CI: 1.02-1.26), > 3 Elixhauser comorbidity (OR: 1.13; CI: 1.05-1.22), nonalcoholic cirrhosis (OR: 1.16; CI: 1.10-1.23), paracentesis on index admission (OR: 1.28; CI: 1.21-1.36) and having hepatocellular carcinoma (OR: 1.21; CI: 1.05; 1.39). Cost of index admission was similar in patients readmitted and not readmitted (P-value: 0.34); however cost of care was significantly more on 30 d readmission ($30959 ± 762) as compared to index admission ($12403 ± 378), P-value: < 0.001.
CONCLUSION
Cirrhotic patients with ascites have a 33% chance of readmission within 30-d. Younger patients, with public insurance, nonalcoholic cirrhosis and increased comorbidity who underwent paracentesis are at increased risk of readmission. Risk factors for unplanned readmission should be targeted given these patients have higher healthcare utilization.
Core tip: Cirrhotic patients with ascites have a 33% chance of 30-d readmission. Factors associated with 30-d readmission include age < 64 years, Medicaid and Medicare insurance, increased comorbidities, nonalcoholic cirrhosis, hepatocellular carcinoma and paracentesis during index admission. Based on identification of these predictors and significant cost involvement, there is need to find ways to counteract them and reduce 30-d readmission rate.
