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Digestive Diseases and Sciences

, Volume 63, Issue 9, pp 2267–2274 | Cite as

Hospital Cirrhosis Volume and Readmission in Patients with Cirrhosis in California

  • Mike WeiEmail author
  • Jason Ford
  • Qihan Li
  • Donghak Jeong
  • Allison J. Kwong
  • Mindie H. Nguyen
  • Matthew S. Chang
Original Article

Abstract

Background

Patients with cirrhosis are at high readmission risk. Using a large statewide database, we evaluated the effect of hospital cirrhosis-related patient volume on 30-day readmissions in patients with cirrhosis.

Methods

We conducted a retrospective study of the Healthcare Cost and Utilization Project State Inpatient Database for adult patients with cirrhosis, as defined by International Classification of Diseases, Ninth Revision (ICD-9) codes, hospitalized in California between 2009 and 2011. Multivariable logistic regression analysis was performed to evaluate the effect of hospital volume on 30-day readmissions.

Results

A total of 69,612 patients with cirrhosis were identified in 405 hospitals; 24,062 patients were discharged from the top 10% of hospitals (N = 41) by cirrhosis volume, and 45,550 patients in the bottom 90% (N = 364). Compared with higher-volume centers, lower-volume hospitals cared for patients with similar average Quan–Charlson–Deyo (QCD) comorbidity scores (6.54 vs. 6.68), similar proportion of hepatitis B and fatty liver disease, lower proportion of hepatitis C (34.8 vs. 41.5%) but greater proportion of alcoholic liver disease (53.1 vs. 47.4%). Multivariable logistic regression analysis demonstrated admission to a lower-volume hospital did not predict 30-day readmission (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.92–1.01) after adjusting for sociodemographics, QCD score, cirrhosis severity, and hospital characteristics. Instead, liver transplant center status significantly decreased the risk of readmission (OR 0.87, 95% CI 0.80–0.94). Ascites, hepatic encephalopathy, hepatocellular carcinoma, higher QCD, and presence of alcoholic liver disease and hepatitis C were also independent predictors.

Conclusions

Readmissions within 30 days were common among patients with cirrhosis hospitalized in California. While hospital cirrhosis volume did not predict 30-day readmissions, liver transplant center status was protective of readmissions. Medically complicated patients with cirrhosis at hospitals without liver transplant centers may benefit from additional support to prevent readmission.

Keywords

Healthcare Cost and Utilization Project Readmission Cost utilization Cirrhosis Hospital volume 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no financial, professional, or personal conflicts of interest to disclose.

Supplementary material

10620_2018_4964_MOESM1_ESM.docx (62 kb)
Supplementary material 1 (DOCX 61 kb)
10620_2018_4964_MOESM2_ESM.docx (92 kb)
Supplementary material 2 (DOCX 92 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Stanford UniversityPalo AltoUSA
  2. 2.Department of GastroenterologyKaiser PermanenteNorthern California, San FranciscoUSA

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