77.11 Readmission Following Liver Transplantation: An Unwanted Occurrence but an Opportunity to Act

Posted on January 18, 2016

M. S. Patel1, J. Mohebali1, J. Shah1, J. F. Markmann1, P. A. Vagefi1 1Massachusetts General Hospital,Division Of Transplant Surgery,Boston, MA, USA

Introduction:
Preventing hospital readmissions remains a priority for providing both quality and cost-effective care. Liver transplant (LT) patients are at high risk for readmission. We sought to identify predictors of readmission and to evaluate its impact on survival in a Region with prolonged waitlist times.

Methods:
A single center review of all consecutive adult, non-living donor LT’s at our center in Region 1 from 2005 to 2014 was performed, with linkage to the UNOS Standard Transplant Analysis and Research registry. Readmission was defined as hospitalization within 90 days of discharge. Logistic regression was used to identify independent predictors of readmission and Kaplan-Meier analysis was used to evaluate overall survival.

Results:
Over the 10-year study period, 325 patients underwent LT with an overall 90-day readmission rate of 46%. Upon multivariable analysis, independent predictors of readmission were age at transplant (OR 0.97[0.94-1] per year), male gender (OR 0.48[0.26-0.88]), hospital length of stay after LT (OR 1.03[1-1.05] per day), hepatitis C as a primary cause of liver failure (OR 2.33[1.40-3.86]), and death (OR 2.19[1.18-4.09]). On overall survival analysis, readmitted patients were noted to have a significantly lower survival compared to those who were not readmitted (p=0.008 on log-rank test, Figure 1) with five-year survival being 74% vs. 88%, respectively. Of those readmitted, only one patient (2.5%) died at the time of initial readmission.

Conclusion:
LT recipients are at substantial risk for readmission with nearly half of all patients re-presenting within 90 days of discharge. As readmission is associated with decreased long-term survival, an emphasis should be placed on optimizing those at increased risk prior to discharge. Furthermore, if readmission does occur, it appears to present an opportunity to intervene, as virtually no patients died during initial readmission.