title: Rates of and Reasons for Hospital Readmissions in Patients With Cirrhosis: A Multistate Population-based Cohort Study.
abstract: There have been few population-based studies of the rates of and reasons for readmission to the hospital within 30 days among patients with cirrhosis.
  
  
  
  We identified all adult patients with cirrhosis who were admitted in 2011 to hospitals in California, Florida Massachusetts, Mississippi, New York, and Washington (119,722 unique index admissions with cirrhosis). We analyzed data from the State Inpatient Databases, which are longitudinal all-payer databases. Data were linked to the American Hospital Association's national survey for hospital characteristics. Outcomes included readmission to any hospital within 30 and 90 days, and the reasons for readmission.
  
  
  
  The 30- and 90-day rates of readmission were 12.9% and 21.2% overall, with limited variation among states. Among patients with more than 3 complications of cirrhosis, 24.2% were readmitted within 30 days and 35.9% were readmitted within 90 days. The presence of hepatic encephalopathy was most strongly associated with readmission within 30 and 90 days (odds ratio, 1.77 for each). Almost 1 in every 4 readmissions was to a different hospital than the one from which the patient was discharged. Among patients with alcoholic liver disease and a history of a complications of cirrhosis, the 2 most common reasons for readmission were acute complications of cirrhosis (in 41.7%) and substance abuse (in 25.0%). Conversely, the most common reasons for readmission of patients with a history of complications of cirrhosis without alcoholic liver disease were acute complications (in 41.0%) and cancer complications (in 16.2%).
  
  
  
  A high proportion of patients with cirrhosis are readmitted to the hospital (often to a different hospital) within 30 or 90 days; encephalopathy is most strongly associated with readmission. Reasons for readmission differ based on the cause of liver disease, and there are opportunities for quality improvement.
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: etapper@bidmc.harvard.edu.
authors.forename: Elliot B
authors.initials: EB
authors.lastname: Tapper
authors.affiliation: Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Brian
authors.initials: B
authors.lastname: Halbert
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Michigan Hospitals, Ann Arbor, Michigan.
authors.forename: Jessica
authors.initials: J
authors.lastname: Mellinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Ascites; Hepatic encephalopathy; Hepatology; Liver Disease