Clinical factors predicting readmission after orthotopic liver transplantation

Hospitals with the highest readmission rates for high-cost conditions may be targeted for payment penalties. The primary aim of this study was to determine clinical predictors of 30-day readmission after discharge for patients undergoing orthotopic liver transplantation (OLT) at the University of Washington from January 2003 to October 2010. Secondary aims included the determination of predictors of institutional care after OLT and differences in survival between patients requiring 30-day readmission and patients not requiring 30-day readmission. Sixty-five of 766 discharged OLT patients (8.6%) required institutional care on discharge; 318 of the 701 remaining patients (45%) were readmitted within 30 days. The predictors of readmission included hospitalization within the 90 days before OLT 29.6% versus 18.4%, relative risk (RR) = 1.33, P = 0.04, pre-OLT portal vein thrombosis (7.9% versus 4.4%, RR = 1.76, P = 0.01), a creatinine level > 1.9 mg/dL (23.9% versus 11.5%, RR = 2.1, P ≤ 0.01), an albumin level < 2.6 mg/dL (51.9% versus 37.6%, RR = 1.57, P < 0.01), postoperative complications (38.7% versus 30.2%, RR = 1.31, P = 0.04), and a high school education or less (14.5% versus 10%, RR = 1.41, P = 0.04). One year after OLT, decreased survival was found for patients requiring 30-day readmission versus patients not requiring readmission (88.2% versus 95.6%, P < 0.05). In conclusion, this study has identified patients at high risk of readmission who may benefit from medical optimization.