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Readmission Rates and Associated Outcomes for Alcoholic Hepatitis: A Nationwide Cohort Study.

Authors
  • Adejumo, Adeyinka C1, 2
  • Cholankeril, George3
  • Iqbal, Umair4
  • Yoo, Eric R5
  • Boursiquot, Brian C3
  • Concepcion, Waldo C6
  • Kim, Donghee3
  • Ahmed, Aijaz3
  • 1 Department of Medicine, North Shore Medical Center, 81 Highland Ave., Salem, MA, 01970, USA. [email protected]
  • 2 Department of Medicine, Tufts University School of Medicine, Boston, MA, USA. [email protected]
  • 3 Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
  • 4 Department of Medicine, Geisinger Medical Center, Danville, PA, USA.
  • 5 Department of Internal Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA.
  • 6 Department of Surgery, Abdominal Transplantation, Stanford University School of Medicine, Stanford, CA, USA.
Type
Published Article
Journal
Digestive Diseases and Sciences
Publisher
Springer-Verlag
Publication Date
Apr 01, 2020
Volume
65
Issue
4
Pages
990–1002
Identifiers
DOI: 10.1007/s10620-019-05759-4
PMID: 31372912
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Alcoholic hepatitis (AH) can lead to sudden and severe hepatic decompensation necessitating recurrent hospitalizations. We evaluated the trends, predictors, and healthcare cost burden of AH-related readmissions in the USA. Utilizing the National Readmissions Database 2010-2014, we performed a retrospective longitudinal analysis to identify the index readmission with AH for up to 90 days after discharge. Annual trends of 30- and 90-day AH-related readmissions were calculated. Predictors of 30- and 90-day readmission were determined by multivariate logistic regression. Annual healthcare cost burden associated with AH-linked readmissions was estimated. Of the 21,572 (unweighted: 50,769) AH-related hospitalizations, 4917 (22.8%) and 7890 (36.6%) were readmitted in 30 and 90 day, respectively, with rates that were statistically unchanged from 2010 to 2014. Predictors of 30-day readmissions included female gender, hepatitis C virus infection, cirrhosis, ascites, acute kidney injury, urinary tract infection, history of bariatric surgery, chronic pancreatitis, and high medical comorbidity index. Acute pancreatitis and palliative care consultation were associated with a lower risk of 30-day readmission. Predictors of 90-day readmission were similar to risk factors for 30-day readmission. From 2010 to 2014, the annual cost (and total hospitalization days) burden increased in 2014 to $164 million (22,244 days) and $321 million (42,772 days) for 30- and 90-day AH-related readmissions, respectively. Despite relatively stable trends in AH-related readmission, the total LOS and cost has been rising. A target-directed approach with a focus on high-risk subpopulations may help understand the unique challenges associated with the rising cost of AH-related readmissions.

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