Inpatient Rehabilitation After Liver Transplantation Decreases Risk and Severity of 30-Day Readmissions

Overview

Journal J Am Coll Surg

Specialties General Surgery
Gynecology & Obstetrics

Date 2016 Apr 7

PMID 27049779

Citations 6

Authors

Anai N Kothari

Ryan M Yau

Robert H Blackwell

Colleen Schaidle-Blackburn

Talar Markossian

Matthew A C Zapf

Amy D Lu

Paul C Kuo

Affiliations

Soon will be listed here.

Abstract

Background: Discharge location is associated with short-term readmission rates after hospitalization for several medical and surgical diagnoses. We hypothesized that discharge location: home, home health, skilled nursing facility (SNF), long-term acute care (LTAC), or inpatient rehabilitation, independently predicted the risk of 30-day readmission and severity of first readmission after orthotopic liver transplantation.

Study Design: We performed a retrospective cohort review using Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases for Florida and California. Patients who underwent orthotopic liver transplantation from 2009 to 2011 were included and followed for 1 year. Mixed-effects logistic regression was used to model the effect of discharge location on 30-day readmission controlling for demographic, socioeconomic, and clinical factors. Total cost of first readmission was used as a surrogate measure for readmission severity and resource use.

Results: A total of 3,072 patients met our inclusion criteria. The overall 30-day readmission rate was 29.6%. Discharge to inpatient rehabilitation (adjusted odds ratio [aOR] 0.43, p = 0.013) or LTAC/SNF (aOR 0.63, p = 0.014) were associated with decreased odds of 30-day readmission when compared with home. The severity of 30-day readmissions for patients discharged to inpatient rehabilitation were the same as those discharged home or home with home health. Severity was increased for those discharged to LTAC/SNF. The time to first readmission was longest for patients discharged to inpatient rehabilitation (17 days vs 8 days, p < 0.001).

Conclusions: When compared with other locations of discharge, inpatient rehabilitation reduces the risk of 30-day readmission and increases the time to first readmission. These benefits come without increasing the severity of readmission. Increased use of inpatient rehabilitation after orthotopic liver transplantation is a strategy to improve 30-day readmission rates.

Citing Articles

Expert consensus on liver transplantation perioperative evaluation and rehabilitation for acute-on-chronic liver failure.

Lv H, Zheng H, Liu J, Cai Q, Ren Y, Yi H Liver Res. 2025; 6(3):121-129.

PMID: 39958201 PMC: 11791836. DOI: 10.1016/j.livres.2022.08.002.

Acute Inpatient Rehabilitation Functional Outcomes and Disposition After Liver Transplant.

Willoughby M, Ramsey-Morrow J, Littell K, Hammond F Arch Rehabil Res Clin Transl. 2024; 6(2):100332.

PMID: 39006115 PMC: 11240025. DOI: 10.1016/j.arrct.2024.100332.

Changes in Functional Outcomes After an Inpatient Rehabilitation Program for Solid-Organ Transplant Recipients.

de Paiva Azevedo M, Nogueira P, DSouza L, Cheung B, Uy K, Patcai J Prog Transplant. 2023; 33(3):201-207.

PMID: 37491867 PMC: 10466989. DOI: 10.1177/15269248231189861.

Identifying and mitigating factors contributing to 30-day hospital readmission in high risk patient populations.

Rogers M, Kuo P Ann Transl Med. 2021; 9(21):1610.

PMID: 34926654 PMC: 8640920. DOI: 10.21037/atm-2021-11.

Pre-transplant Sarcopenic Obesity Worsens the Survival After Liver Transplantation: A Meta-Analysis and a Systematic Review.

Hegyi P, Soos A, Hegyi P, Szakacs Z, Hanak L, Vancsa S Front Med (Lausanne). 2021; 7:599434.

PMID: 33392221 PMC: 7772841. DOI: 10.3389/fmed.2020.599434.

References

Paterno F, Wilson G, Wima K, Quillin 3rd R, Abbott D, Cuffy M . Hospital utilization and consequences of readmissions after liver transplantation. Surgery. 2014; 156(4):871-8. DOI: 10.1016/j.surg.2014.06.018. View

Chen P, Wang W, Yan L, Yang J, Wen T, Li B . Risk factors for first-year hospital readmission after liver transplantation. Eur J Gastroenterol Hepatol. 2015; 27(5):600-6. DOI: 10.1097/MEG.0000000000000327. View

Ladner D, Skaro A, Abecassis M . Are all readmissions the same?. Liver Transpl. 2012; 18(9):1007-8. DOI: 10.1002/lt.23517. View

Vinson J, Rich M, Sperry J, Shah A, McNamara T . Early readmission of elderly patients with congestive heart failure. J Am Geriatr Soc. 1990; 38(12):1290-5. DOI: 10.1111/j.1532-5415.1990.tb03450.x. View

Pereira A, Bhattacharya R, Carithers R, Reyes J, Perkins J . Clinical factors predicting readmission after orthotopic liver transplantation. Liver Transpl. 2012; 18(9):1037-45. DOI: 10.1002/lt.23475. View

Ottenbacher K, Graham J, Ottenbacher A, Lee J, Al Snih S, Karmarkar A . Hospital readmission in persons with stroke following postacute inpatient rehabilitation. J Gerontol A Biol Sci Med Sci. 2012; 67(8):875-81. PMC: 3403861. DOI: 10.1093/gerona/glr247. View

Kastenberg Z, Morton J, Visser B, Norton J, Poultsides G . Hospital readmission after a pancreaticoduodenectomy: an emerging quality metric?. HPB (Oxford). 2013; 15(2):142-8. PMC: 3719921. DOI: 10.1111/j.1477-2574.2012.00563.x. View

New P, Andrianopoulos N, Cameron P, Olver J, Stoelwinder J . Reducing the length of stay for acute hospital patients needing admission into inpatient rehabilitation: a multicentre study of process barriers. Intern Med J. 2013; 43(9):1005-11. DOI: 10.1111/imj.12227. View

Yu J, Hosmer A, Parks T, Sonnenday C, Sharma P . Predictors of Early Hospitalization After Deceased Donor Liver Transplantation. Dig Dis Sci. 2015; 60(11):3242-7. PMC: 4743740. DOI: 10.1007/s10620-015-3753-2. View

10.

Wilson G, Hoehn R, Ertel A, Wima K, Quillin 3rd R, Hohmann S . Variation by center and economic burden of readmissions after liver transplantation. Liver Transpl. 2015; 21(7):953-60. DOI: 10.1002/lt.24112. View

11.

McAdams-DeMarco M, Grams M, Hall E, Coresh J, Segev D . Early hospital readmission after kidney transplantation: patient and center-level associations. Am J Transplant. 2012; 12(12):3283-8. DOI: 10.1111/j.1600-6143.2012.04285.x. View

12.

Martin R, Brown R, Puffer L, Block S, Callender G, Quillo A . Readmission rates after abdominal surgery: the role of surgeon, primary caregiver, home health, and subacute rehab. Ann Surg. 2011; 254(4):591-7. DOI: 10.1097/sla.0b013e3182300a38. View

13.

Riggs R, Roberts P, Aronow H, Younan T . Joint replacement and hip fracture readmission rates: impact of discharge destination. PM R. 2010; 2(9):806-10. DOI: 10.1016/j.pmrj.2010.05.008. View

14.

Dunlay S, Pack Q, Thomas R, Killian J, Roger V . Participation in cardiac rehabilitation, readmissions, and death after acute myocardial infarction. Am J Med. 2014; 127(6):538-46. PMC: 4035431. DOI: 10.1016/j.amjmed.2014.02.008. View

15.

Kansagara D, Englander H, Salanitro A, Kagen D, Theobald C, Freeman M . Risk prediction models for hospital readmission: a systematic review. JAMA. 2011; 306(15):1688-98. PMC: 3603349. DOI: 10.1001/jama.2011.1515. View

16.

Williams M . A requirement to reduce readmissions: take care of the patient, not just the disease. JAMA. 2013; 309(4):394-6. DOI: 10.1001/jama.2012.233964. View

17.

Shay P, Ozcan Y . Freestanding inpatient rehabilitation facility performance following the 60 percent rule: a matter of fit. Med Care Res Rev. 2012; 70(1):46-67. DOI: 10.1177/1077558712453206. View

18.

Grimes D . Epidemiologic research with administrative databases: red herrings, false alarms and pseudo-epidemics. Hum Reprod. 2015; 30(8):1749-52. DOI: 10.1093/humrep/dev151. View

19.

Merkow R, Ju M, Chung J, Hall B, Cohen M, Williams M . Underlying reasons associated with hospital readmission following surgery in the United States. JAMA. 2015; 313(5):483-95. DOI: 10.1001/jama.2014.18614. View

20.

Vaughan Sarrazin M, Rosenthal G . Finding pure and simple truths with administrative data. JAMA. 2012; 307(13):1433-5. DOI: 10.1001/jama.2012.404. View