This journal club article was taken from this month’s American Journal of Gastroenterology. Four hundred patients with an index admission for a decompensating cirrhotic event (encephalopathy, variceal bleeding, hepatorenal syndrome, large volume paracentesis) were followed for subsequent hospital readmissions. It was a retrospective study, conducted by review of patient charts. The aims of this study were to identify the frequency, costs, predictors, and preventable causes of hospital readmissions among patients with decompensated cirrhosis.
Median time to readmission was 67 days. One week after discharge, 14% of patients were readmitted, and 37% were readmitted within one month. Cost of hospitalization was more for those admitted in the first week. The three main predictors of hospital readmission, identified on multivariate analysis, were MELD score, serum sodium and number of medications on discharge. About 22% of readmissions were deemed to be preventable. It seems as though better patient education upon discharge, ie. knowing when to seek medical attention, is a way to decrease readmissions. It should be noted that frequent admissions were independently associated with increased mortality.
In the future, data like this may be utilized to construct patient educational tools and thereby decrease readmission rates. A similar approach was used successfully to decrease admission rates for patients with congestive heart failure.
To read the full article from the American Journal of Gastroenterology, Sept. 2011, click below: