title: Burden of decompensated cirrhosis and ascites on hospital services in a tertiary care facility: time for change?
abstract: BACKGROUND
  Ascites, the most frequent complication of cirrhosis, is associated with poor prognosis and reduced quality of life. Recurrent hospital admissions are common and often unplanned, resulting in increased use of hospital services.
  
  
  OBJECTIVE
  To examine use of hospital services by patients with cirrhosis and ascites requiring paracentesis, and to investigate factors associated with early unplanned readmission.
  
  
  METHODS
  A retrospective review of the medical chart and clinical databases was performed for patients who underwent paracentesis between October 2011 and October 2012. Clinical parameters at index admission were compared between patients with and without early unplanned hospital readmissions.
  
  
  RESULTS
  The 41 patients requiring paracentesis had 127 hospital admissions, 1164 occupied bed days and 733 medical imaging services. Most admissions (80.3%) were for management of ascites, of which 41.2% were unplanned. Of those eligible, 69.7% were readmitted and 42.4% had an early unplanned readmission. Twelve patients died and nine developed spontaneous bacterial peritonitis. Of those eligible for readmission, more patients died (P = 0.008) and/or developed spontaneous bacterial peritonitis (P = 0.027) if they had an early unplanned readmission during the study period. Markers of liver disease, as well as haemoglobin (P = 0.029), haematocrit (P = 0.024) and previous heavy alcohol use (P = 0.021) at index admission, were associated with early unplanned readmission.
  
  
  CONCLUSIONS
  Patients with cirrhosis and ascites comprise a small population who account for substantial use of hospital services. Markers of disease severity may identify patients at increased risk of early readmission. Alternative models of care should be considered to reduce unplanned hospital admissions, healthcare costs and pressure on emergency services.
authors.affiliation: Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Centre for Liver Disease Research, School of Medicine, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia.
authors.forename: K J
authors.initials: KJ
authors.lastname: Fagan
authors.forename: E Y
authors.initials: EY
authors.lastname: Zhao
authors.forename: L U
authors.initials: LU
authors.lastname: Horsfall
authors.forename: B J
authors.initials: BJ
authors.lastname: Ruffin
authors.forename: M S
authors.initials: MS
authors.lastname: Kruger
authors.forename: S M
authors.initials: SM
authors.lastname: McPhail
authors.forename: P
authors.initials: P
authors.lastname: O'Rourke
authors.forename: E
authors.initials: E
authors.lastname: Ballard
authors.forename: K M
authors.initials: KM
authors.lastname: Irvine
authors.forename: E E
authors.initials: EE
authors.lastname: Powell
mesh_terms: D001201:Ascites / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D001315:Australia / Q000453:epidemiology; D017281:Cost of Illness; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000191:economics / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000191:economics* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D063128:Tertiary Health Care / Q000191:economics*; D013997:Time Factors
keywords: chronic liver disease; healthcare cost; hospital readmission; models of care; paracentesis; spontaneous bacterial peritonitis