Alvaro Castillo, MD1, Allison D Rice, MD1, Kristian C Enestvedt, MD2, Joshua Parreco, MD1, Susan L Orloff, MD2. 1University of Miami, 2Oregon Health and Science University
Introduction: Hospital readmissions are becoming an important quality metric in liver transplantation. However, limited data exist examining the relationship between center experience and readmission rates. The purpose of this study was to evaluate the risk factors for readmission after liver transplant to determine performance and costs stratified by transplant center volume.
Methods: The Nationwide Readmissions Database for 2010-2014 was queried for all adult patients undergoing liver transplant in the U.S. The outcomes of interest were non-elective readmission to index and non-index hospitals within 180 days. High volume centers were identified as performing the highest quartile of liver transplants each year. Univariable analysis was performed for the outcomes of interest and the significant variables were used for multivariable logistic regression. Costs were calculated using the cost to charge ratio and results were weighted for national estimates.
Results: There were 33,287 patients who underwent liver transplant during the study period. The highest quartile centers performed between 80 and 177 procedures per year (unweighted). The readmission rate within 180 days was 36.4%, of which 7.6% were readmitted to a non-index hospital. The median initial admission cost was $94,215 ($67,183-$145,487) and median readmission cost was $17,341 ($7,249-$40,181). High volume centers performed 52.1% of procedures and were associated with a decreased median initial admission cost ($85,091 [$63,274-$131,852] vs $103,727 [$73,838-$161,228] p<0.01) and decreased median readmission cost ($16,579 [$6,929-$39,299] vs $18,001 [$7,799-$40,476] p<0.01). High volume hospitals were also associated with a decreased risk for readmission (OR 0.71 [0.68-0.75] p<0.01) however, they were associated with an increased risk for readmission to a different hospital (OR 1.83 [1.56-2.14] p<0.01). The most common primary diagnosis code on readmission was “complications of transplanted liver” (25.0%) and on readmission to a non-index hospital was “acute kidney failure” (7.8%).
Conclusions: This study represents the first nationwide evaluation of readmission after liver transplant including readmissions to hospitals outside the liver transplant network. High volume liver transplant centers were associated with decreased cost and readmission rates. However, these centers have an increased risk for readmission to a non-index hospital. These findings have implications for quality metrics, benchmarking, regional transfer patterns, and readmission reduction strategies.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93894
Program Number: P604
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster