Adherence to American Association for the Study of Liver Diseases (AASLD) Guidelines and Predictors of Readmission in Cirrhotic Patients: A Single Center Experience

Abstract

Introduction: Liver cirrhosis (LC) is a major cause of mortality and morbidity in the United States. American Association for the Study of Liver Disease (AASLD) has developed guidelines for the management of patients with LC. Methods: We conducted a one-year retrospective chart review study of patients admitted with LC related complication. Our primary outcome was adherence to AASLD guidelines for the management of variceal bleeding (VB), fluid overload and hepatocellular carcinoma (HCC) screening, and secondary outcome was re-admission rate within 30 days of discharge. Results: A total of 139 patients were reviewed. Majority were males (65%) and Caucasians (65%). The admission indication was mainly for fluid overload (39%), hepatic encephalopathy (36%) and VB (27%). The one-month readmission rate was 31%, of those 47% and 37% were admitted for hepatic encephalopathy and fluid overload respectively. Periodic screening for HCC was done in only 40% of patients. Ninety-five percent of patients admitted with VB received PPI, octreotride and antibiotics. Diet education was only documented in 9% of patients on discharge. Significant predictors for 30-day readmission included high MELD score, elevated creatinine, and taking diuretics/lactulose before hospitalization in addition to shorter length of stay. Conclusion: Compliance with AASLD guidelines was optimal for patients with VB. Further optimization is required for HCC screening and patient education. Multiple factors play a role in readmissions for patients with cirrhosis; this model helps to identify patients at risk for readmission and opens an area for quality improvement measures to avoid unnecessary hospitalizations.