Inpatient Rehabilitation after Liver Transplantation Decreases Risk and Severity of 30-Day Readmissions

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• 作者：Anai N. Kothari ; MD^a ; ^c ; Ryan M. Yau^c ; Robert H. Blackwell ; MD^b ; ^c ; Colleen Schaidle-Blackburn ; ANP-BC^a ; Talar Markossian ; PhD^d ; Matthew A.C. Zapf ; BA^a ; ^c ; Amy D. Lu ; MD ; MPH ; MBA ; FACS^a ; ^c ; Paul C. Kuo ; MD ; MS ; MBA ; FACS^a ; ^c ; ^{paul.kuo@luhs.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：AIC ; Akaike information criterion ; CMS ; Centers for Medicare and Medicaid Services ; HCUP SID ; Healthcare Cost and Utilization Project State Inpatient Databases ; HRRP ; Hospital Readmission Reduction Program ; IQR ; interquartile range ; LTAC ; long-term acute care ; OR ; odds ratio ; SHR ; subdistribution hazard ratio ; SNF ; skilled nursing facility
• 刊名：Journal of the American College of Surgeons
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：223
• 期：1
• 页码：164-171.e2
• 全文大小：454 K

文摘

Discharge location is associated with short-term readmission rates after hospitalization for several medical and surgical diagnoses. We hypothesized that discharge location: home, home health, skilled nursing facility (SNF), long-term acute care (LTAC), or inpatient rehabilitation, independently predicted the risk of 30-day readmission and severity of first readmission after orthotopic liver transplantation.

<h4 id="absSec_2">Study Designh4>

We performed a retrospective cohort review using Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases for Florida and California. Patients who underwent orthotopic liver transplantation from 2009 to 2011 were included and followed for 1 year. Mixed-effects logistic regression was used to model the effect of discharge location on 30-day readmission controlling for demographic, socioeconomic, and clinical factors. Total cost of first readmission was used as a surrogate measure for readmission severity and resource use.

<h4 id="absSec_3">Resultsh4>

A total of 3,072 patients met our inclusion criteria. The overall 30-day readmission rate was 29.6%. Discharge to inpatient rehabilitation (adjusted odds ratio [aOR] 0.43, p = 0.013) or LTAC/SNF (aOR 0.63, p = 0.014) were associated with decreased odds of 30-day readmission when compared with home. The severity of 30-day readmissions for patients discharged to inpatient rehabilitation were the same as those discharged home or home with home health. Severity was increased for those discharged to LTAC/SNF. The time to first readmission was longest for patients discharged to inpatient rehabilitation (17 days vs 8 days, p < 0.001).

<h4 id="absSec_4">Conclusionsh4>

When compared with other locations of discharge, inpatient rehabilitation reduces the risk of 30-day readmission and increases the time to first readmission. These benefits come without increasing the severity of readmission. Increased use of inpatient rehabilitation after orthotopic liver transplantation is a strategy to improve 30-day readmission rates.