Adverse Effect of Post-Discharge Care Fragmentation on Outcomes after Readmissions after Liver Transplantation Journal Article


Authors: Kothari, A. N.; Loy, V. M.; Brownlee, S. A.; Ezure, Y.; Schaidle-Blackburn, C.; Cotler, S. J.; di Sabato, D; Kuo, P. C.; Lu, A. D.
Article Title: Adverse Effect of Post-Discharge Care Fragmentation on Outcomes after Readmissions after Liver Transplantation
Abstract: BACKGROUND: Post-discharge surgical care fragmentation is defined as readmission to any hospital other than the hospital at which the surgery was performed. The objective of this study was to assess the impact of fragmented readmissions within the first year following orthotopic liver transplant (OLT). STUDY DESIGN: The Healthcare Cost and Utilization Project State Inpatient Databases (HCUP SID) for Florida and California from 2006-2011 were used to identify OLT patients. Post-discharge fragmentation was defined as any readmission to a non-index hospital, including readmitted patients transferred to the index hospital after 24 hours. Outcomes included adverse events defined as 30-day mortality and 30-day readmission following a fragmented readmission. All statistical analyses considered a hierarchical data structure and were performed with multilevel, mixed-effects models. RESULTS: 2,996 patients with 7,485 readmission encounters at 299 hospitals were analyzed. 1,236 (16.5%) readmissions were fragmented. Following adjustment for age, sex, readmission reason, index liver transplant cost, readmission length of stay, number of previous readmissions, and time from transplant, post-discharge fragmentation increased the odds of both 30-day mortality (OR 1.75, 1.16 - 2.65) and 30-day readmission (OR 2.14, 1.83 - 2.49). Predictors of adverse events following a fragmented readmission included: increased number of previous readmissions (OR 1.07, 1.01 - 1.14) and readmission within 90 days of OLT (OR 2.19, 1.61 - 2.98). CONCLUSION: Post-discharge fragmentation significantly increases the risk of both 30-day mortality and subsequent readmission after a readmission in the first year after OLT. More inpatient visits prior to a readmission and less time elapsed from index surgery increases the odds of an adverse event following discharge from a fragmented readmission. These parameters could guide transfer decisions for patients with post-discharge fragmentation.
Keywords: care fragmentation; orthotopic liver transplant; postoperative readmissions
Journal Title: Journal of the American College of Surgeons
ISSN: 1879-1190; 1072-7515
Publisher: Elsevier Inc  
Journal Place: United States
Date Published: 2017
Language: eng
DOI/URL:
Notes: LR: 20170412; CI: Copyright (c) 2017; JID: 9431305; OTO: NOTNLM; 2017/01/15 [received]; 2017/01/15 [revised]; 2017/03/26 [accepted]; aheadofprint