Hospital Cirrhosis Volume and Readmission in Patients with Cirrhosis in California
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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.
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.
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.
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.
KeywordsHealthcare Cost and Utilization Project Readmission Cost utilization Cirrhosis Hospital volume
Compliance with ethical standards
Conflict of interest
All authors declare that they have no financial, professional, or personal conflicts of interest to disclose.
- 4.Neff GW, Duncan CW, Schiff ER. The current economic burden of cirrhosis. Gastroenterol Hepatol. 2011;7:661–671.Google Scholar
- 5.Tapper EB, Halbert B, Mellinger J. Rates of and reasons for hospital readmissions in patients with cirrhosis: a multistate population-based cohort study. Clin Gastroenterol Hepatol. 2016;14:e1182.Google Scholar
- 6.National Center for Health Statistics. Hospital Utilization (in non-Federal short-stay hospitals). CDC/National Center for Health Statistics. 2016. Available at: https://www.cdc.gov/nchs/fastats/hospital.htm. Accessed July 5, 2017.
- 8.Miller ME. Report to the Congress: Reforming the Delivery System. Washington, DC: Medicare Payment Advisory Commission; 2008.Google Scholar
- 21.U.S. Census Bureau: QuickFacts—California. U.S. Census Bureau, U.S. Department of Commerce, 2017. Available at: https://www.census.gov/quickfacts/. Accessed July 5, 2017.