title: Hospital utilization and consequences of readmissions after liver transplantation.
abstract: BACKGROUND
  Preventable readmissions have become a focal point for controlling cost and improving quality in medicine. The frequency and causes of readmissions after liver transplantation (OLT) at 30 days and 1 year have not been described. We aimed to determine the risk factors, rate, and outcomes of readmissions within the first year after OLT and its potential impact on patient and graft survival.
  
  
  METHODS
  Medical records of 239 consecutive patients who underwent OLT from 2007 to 2012 at University of Cincinnati Medical Center were reviewed. Fifteen patients were excluded owing to death (n = 11) or retransplantation (n = 4) within the same hospital stay. Transplant- and non-transplant-related factors were collected during the index admissions and potential readmissions. This database was then linked to the Scientific Registry of Transplant Recipients to link donor- and recipient-related data.
  
  
  RESULTS
  One hundred fifty-four patients (69%) were readmitted within 1 year after OLT, for a total of 413 readmissions (average, 2.7 readmissions per patient) and a median hospital length of stay of 4 days. There were 118 readmissions within the first 30 days in 41% of patients (92/224). Sixty-five percent of patients readmitted within 30 days after discharge (69/92) were hospitalized again at least once within the year. Twenty-nine percent of patients (64/224) were discharged to a rehabilitation center after OLT; if discharged to a rehabilitation center, these patients had a 53% and 81% risk of readmission in 30 days and 1 year, respectively, compared with patients discharged home (36% and 64%, respectively; P = .02). The most common reasons for readmission within the first 30 days after discharge were infection (19.5%), renal insufficiency (9.3%), vomiting/diarrhea (8.5%), and pulmonary edema/effusion (7.6%). The most common reasons for readmission after 1 month were infection (24.8%), acute cellular rejection (8.5%), and biliary complications (7.1%). Risk factors for readmission included presence of diabetes (odds ratio [OR], 2.3; 95% CI, 1.2-4.6) and albumin <2.5 g/dL at OLT (OR, 2.3; 95%, CI 1.1-5.1). Readmissions within 30 days or 1 year were associated with decreased long-term graft and patient survival.
  
  
  CONCLUSIONS
  Readmissions after OLT represent a significant health care burden, with 41% of patients readmitted within 30 days of discharge and 69% at 1 year. Readmittance is associated with worse long-term outcomes and significantly reduced patient and graft survival. These data confirm that further efforts are needed to predict and circumvent treatable causes for readmission to improve health care costs, quality, and ultimately survival after OLT.
authors.affiliation: Cincinnati Clinical Research Group in Surgery, Division of Transplantation, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH. Electronic address: flavio.paterno@uc.edu.
authors.forename: Flavio
authors.initials: F
authors.lastname: Paterno
authors.affiliation: Cincinnati Clinical Research Group in Surgery, Division of Transplantation, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Wilson
authors.affiliation: Cincinnati Clinical Research Group in Surgery, Division of Transplantation, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Koffi
authors.initials: K
authors.lastname: Wima
authors.affiliation: Cincinnati Clinical Research Group in Surgery, Division of Transplantation, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Ralph C
authors.initials: RC
authors.lastname: Quillin
authors.affiliation: Cincinnati Clinical Research Group in Surgery, Division of Transplantation, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.affiliation: Cincinnati Clinical Research Group in Surgery, Division of Transplantation, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Madison C
authors.initials: MC
authors.lastname: Cuffy
authors.affiliation: Cincinnati Clinical Research Group in Surgery, Division of Transplantation, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Tayyab S
authors.initials: TS
authors.lastname: Diwan
authors.affiliation: Cincinnati Clinical Research Group in Surgery, Division of Transplantation, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Kaiser
authors.affiliation: Cincinnati Clinical Research Group in Surgery, Division of Transplantation, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: E Steve
authors.initials: ES
authors.lastname: Woodle
authors.affiliation: Cincinnati Clinical Research Group in Surgery, Division of Transplantation, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors