Adherence to American Association for the Study of Liver Diseases (AASLD) Guidelines and Predictors of Readmission in Cirrhotic Patients: A Single Center Experience
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.
Cite this paper
Masadeh, M. M. , Zaied, A. , Hussain, F. , Spratt, H. and Soloway, R. (2015). Adherence to American Association for the Study of Liver Diseases (AASLD) Guidelines and Predictors of Readmission in Cirrhotic Patients: A Single Center Experience. Open Access Library Journal, 2, e1593. doi: http://dx.doi.org/10.4236/oalib.1101593.
CDC/NCHS. National Hospital Discharge Survey (2010) Detailed Diagnosis and Procedure Tables; Number
of First- Listed
Diagnoses for Discharges from Short-Stay Hospitals, by ICD-9-CM Code, Sex, Age,
and Geographic Region.
Martínez-Noguera, A.,
Montserrat, E.,
Torrubia, S. and Villalba, J. (2002) Doppler in Hepatic Cirrhosis and Chronic Hepatitis. Seminars in Ultrasound, CT and MRI, 23, 19-36. http://dx.doi.org/10.1016/S0887-2171(02)90027-2
Johnson, E.A.,
Spier, B.J.,
Leff, J.A.,
Lucey, M.R. and Said, A.
(2011) Optimising
the Care of Patients with Cirrhosis and Gastrointestinal Haemorrhage: A Quality
Improvement Study. Alimentary Pharmacology
& Therapeutics, 34, 76- 82. http://dx.doi.org/10.1111/j.1365-2036.2011.04692.x
Garcia-Tsao, G. and Bosch, J.
(2010) Management
of Varices and Variceal Hemorrhage in Cirrhosis. The New England Journal of Medicine, 362, 823-832. http://dx.doi.org/10.1056/NEJMra0901512
El-Serag, H.B. and Mason, A.C. (1999) Rising
Incidence of Hepatocellular Carcinoma in the United States. The New England Journal of Medicine, 340, 745-750. http://dx.doi.org/10.1056/NEJM199903113401001
Zhang, B.H.,
Yang, B.H. and Tang, Z.Y. (2004) Randomized
Controlled Trial of Screening for Hepatocellular Carcinoma. Journal of Cancer Research and Clinical
Oncology, 130, 417-422. http://dx.doi.org/10.1007/s00432-004-0552-0
Volk, M.L.,
Tocco, R.S.,
Bazick, J.,
Rakoski, M.O. and Lok, A.S. (2012) Hospital
Readmissions among Patients with Decompensated Cirrhosis. The American Journal of Gastroenterology, 107, 247-252. http://dx.doi.org/10.1038/ajg.2011.314
Garcia-Tsao, G.,
Sanyal, A.J.,
Grace, N.D. and Carey, W.
(2007) Prevention
and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis. Hepatology (Baltimore, Md), 46, 922-938. http://dx.doi.org/10.1002/hep.21907
Harris, P.A.,
Taylor, R.,
Thielke, R.,
Payne, J.,
Gonzalez, N. and Conde, J.G. (2009) Research
Electronic Data Capture (REDCap)—A Metadata-Driven Methodology and Workflow
Process for Providing Translational Research Informatics Support. Journal of Biomedical Informatics, 42, 377-381. http://dx.doi.org/10.1016/j.jbi.2008.08.010
Runyon, B.A. (2009) Management
of Adult Patients with Ascites Due to Cirrhosis: An Update. Hepatology (Baltimore, Md), 49, 2087-2107. http://dx.doi.org/10.1002/hep.22853
Bruix, J. and Sherman, M., American Association for the Study of Liver D (2011) Management of Hepatocellular Carcinoma: An
Update. Hepatology (Baltimore, Md), 53, 1020-1022. http://dx.doi.org/10.1002/hep.24199
Berman, K.,
Tandra, S.,
Forssell, K., et al. (2011) Incidence and Predictors of 30-Day Readmission among
Patients Hospitalized for Advanced Liver Disease. Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological
Association, 9, 254-259. http://dx.doi.org/10.1016/j.cgh.2010.10.035
Shu, C.C., Lin, Y.F., Hsu, N.C.
and Ko, W.J. (2012) Risk Factors for 30-Day Readmission in General
Medical Patients Admitted from the Emergency Department: A Single Centre Study. Internal Medicine Journal, 42, 677-682. http://dx.doi.org/10.1111/j.1445-5994.2011.02562.x