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Hospital Readmissions in Patients with Cirrhosis: A Systematic Review
Author(s) -
Orman Eric S.,
Ghabril Marwan,
Emmett Thomas W.,
Chalasani Naga
Publication year - 2018
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.12788/jhm.2967
Subject(s) - medicine , cinahl , cirrhosis , medline , inclusion and exclusion criteria , psychological intervention , data extraction , cochrane library , population , chronic liver disease , liver disease , confidence interval , model for end stage liver disease , intensive care medicine , emergency medicine , liver transplantation , alternative medicine , psychiatry , environmental health , transplantation , pathology , political science , law
BACKGROUND Hospital readmission is a significant problem for patients with complex chronic illnesses such as liver cirrhosis. PURPOSE We aimed to describe the range of readmission risk in patients with cirrhosis and the impact of the model for end‐stage liver disease (MELD) score. DATA SOURCES We conducted a systematic review of studies identified in Ovid MEDLINE, PubMed, EMBASE, CINAHL, the Cochrane Library, Scopus, Google Scholar, and ClinicalTrials.gov from 2000 to May 2017. STUDY SELECTION We examined studies that reported early readmissions (up to 90 days) in patients with cirrhosis. Studies were excluded if they did not examine the association between readmission and at least 1 variable or intervention. DATA EXTRACTION Two reviewers independently extracted data on study design, setting, population, interventions, comparisons, and detailed information on readmissions. DATA SYNTHESIS Of the 1363 records reviewed, 26 studies met the inclusion and exclusion criteria. Of these studies, 21 were retrospective, and there was significant variation in the inclusion and exclusion criteria. The pooled estimate of 30‐day readmissions was 26%(95% confidence interval [CI], 22%‐30%). Few studies examined readmission preventability or the relationship between readmissions and social determinants of health. Reasons for readmission were highly variable. An increased MELD score was associated with readmissions in most studies. Readmission was associated with increased mortality. CONCLUSION Hospital readmissions frequently occur in patients with cirrhosis and are associated with liver disease severity. The impact of functional and social factors on readmissions is unclear.