A206 PREDICTORS OF HOSPITAL READMISSION FOLLOWING LIVER TRANSPLANTATION: A SINGLE CENTRE EXPERIENCE

Abstract

Background: Hospital readmission is a predictor of increased resource utilization and the quality of care delivered. Advances in liver transplantation have dramatically decreased morbidity and mortality, but hospital readmission remains elevated. The purpose of this study is to determine predictors of hospital readmission in patients that underwent liver transplantation. Methods: This is a retrospective cohort study conducted at London Health Sciences Centre, a tertiary care centre, in London, Ontario, Canada. All patient who underwent liver transplantation between 2012 and 2016 were included in this study. Charts were reviewed to collect patient demographics, donor organ variables, readmission rates, and post-operative complications. Statistical analysis was performed with multivariable logistic regression. A p value <0.05 was statistically significant. Results: There were 255 patients that underwent liver transplantation with a median age of 60 (range 23-71) years old and 31% were female. The most common cause for liver transplantation was hepatitis C in 33%, hepatocellular carcinoma in 32%, and alcohol in 19%. The median MELD score was 21 (range 6-40). Of the liver transplants performed, 83% were from brain dead donors, 15% were from donors after cardiac death, and 2% were from living donors. The mean donor risk index was 1.68±0.4. Patients required readmission in 17% of cases after being discharged. The most common cause of readmission was elevated liver enzymes in 6%, graft failure in 5%, and infection in 3%. The most common post-operative complications were medical infections (e.g. pneumonia) in 18%, abdominal bleeding in 12%, malnutrition in 11%, and biliary complications in 6% while portal vein thrombosis occurred in 3% and hepatic artery thrombosis in 1%. Death occurred in 9% during the follow up period. On multivariable logistic regression, both hepatocellular carcinoma (OR 0.27, CI (0.10-0.70), p=0.007) and alcoholic liver disease (OR 0.20, CI (0.06-0.73), p=0.014) were protective against readmission while biliary complications (OR 4.03, CI (1.22-13.31), p=0.022) increased the risk. Conclusions: Hospital readmission post-liver transplantation is common which leads to increased healthcare resource utilization. Post-operative biliary complications are the only clinical predictor of readmission within 90 days of discharge while hepatocellular carcinoma and alcoholic liver disease are protective against readmission.