Why are Patients with Cirrhosis Readmitted to the Hospital?

by Joseph Esherick, M.D., FAAFP, FHM

Patients diagnosed with cirrhosis are regularly admitted and readmitted to the hospital. Statistics show that the 90-day readmission rate is approximately 50%.

A recent study analyzed the rate of readmission at 30-days and 90-days and the relevant causes among patients with cirrhosis who were admitted. This study took place in 2011 throughout several hospitals in the United States.

Overall Rates of Readmission (n=119,722)

30-day

90-day

13%

21%

 

Readmission Rates Among Patients with Three or More Complications of Cirrhosis

30-day

90-day

24%

36%


Complications of cirrhosis included ascites, gastroesophageal varices, hepatorenal syndrome, spontaneous bacterial peritonitis, or hepatic encephalopathy. Hepatic encephalopathy was the most important predictor of readmission.

Overall, 40% of readmissions were attributed to acute complications of cirrhosis in those with prior complications of cirrhosis. In patients with alcoholic liver disease, substance abuse caused the second most cases of readmission at 25%. In patients with nonalcoholic liver disease, cancer complications accounted for a 16% readmission rate.

 

 

Comment

The presence of hepatic encephalopathy is an important predictor of readmission. It begs for systems-level improvement in care pathways to reduce readmission for this diagnosis.

Patients with alcoholic liver disease are frequently readmitted due to substance abuse. Linking these patients to substance abuse programs could help reduce readmissions.

Finally, patients with non-alcoholic liver disease (especially hepatitis C virus-related or hepatitis B virus-related cirrhosis) frequently develop hepatocellular cancer.  Frequent screening of such patients using alfa-fetoprotein (AFP) and liver ultrasound exams can detect hepatocellular cancer at an early stage when it is potentially curable.

 

Citation(s):

  1. Tapper EB et al. Rates of and reasons for hospital readmissions in patients with cirrhosis: A multistate population-based cohort study. Clin Gastroenterol Hepatol 2016 Aug; 14:1181. (http://dx.doi.org/10.1016/j.cgh.2016.04.009)