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Risk Factors for Frequent Readmissions and Barriers to Transplantation in Patients with Cirrhosis

Ganesh, S and Rogal, SS and Yadav, D and Humar, A and Behari, J (2013) Risk Factors for Frequent Readmissions and Barriers to Transplantation in Patients with Cirrhosis. PLoS ONE, 8 (1).

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Background: Hospital readmission rate is receiving increasing regulatory scrutiny. Patients with cirrhosis have high hospital readmissions rates but the relationship between frequent readmissions and barriers to transplantation remains unexplored. The goal of this study was to determine risk factors for frequent readmissions among patients with cirrhosis and identify barriers to transplantation in this population. Methods: We retrospectively reviewed medical records of 587 patients with a confirmed diagnosis of cirrhosis admitted to a large tertiary care center between May 1, 2008 and May 1, 2009. Demographics, clinical factors, and outcomes were recorded. Multivariate logistic regression was performed to identify risk factors for high readmission rates. Transplant-related factors were assessed for patients in the high readmission group. Results: The 587 patients included in the study had 1557 admissions during the study period. A subset of 87 (15%) patients with 5 or more admissions accounted for 672 (43%) admissions. The factors associated with frequent admissions were non-white race (OR = 2.45, p = 0.01), diabetes (OR = 2.04, p = 0.01), higher Model for End-Stage Liver Disease (MELD) score (OR = 35.10, p<0.0001 for MELD>30) and younger age (OR = 0.98, p = 0.02). Among the 87 patients with ≥5 admissions, only 14 (16%) underwent liver transplantation during the study period. Substance abuse, medical co-morbidities, and low (<15) MELD scores were barriers to transplantation in this group. Conclusions: A small group of patients with cirrhosis account for a disproportionately high number of hospital admissions. Interventions targeting this high-risk group may decrease frequent hospital readmissions and increase access to transplantation. © 2013 Ganesh et al.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Ganesh, S
Rogal, SSssr24@pitt.eduSSR24
Yadav, Ddhy2@pitt.eduDHY2
Humar, Aabh24@pitt.eduABH24
Behari, Jjab31@pitt.eduJAB31
Date: 28 January 2013
Date Type: Publication
Journal or Publication Title: PLoS ONE
Volume: 8
Number: 1
DOI or Unique Handle: 10.1371/journal.pone.0055140
Schools and Programs: School of Medicine > Medicine
School of Medicine > Surgery
Refereed: Yes
Other ID: NLM PMC3557253
PubMed Central ID: PMC3557253
PubMed ID: 23383085
Date Deposited: 14 Mar 2013 14:43
Last Modified: 02 Feb 2019 13:58


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