Burden of decompensated cirrhosis and ascites on hospital services in a tertiary care facility: time for change?

Fagan, K. J., Zhao, Eileen Y., Horsfall, L. U., Ruffin, Brittany J., Kruger, Mark S., McPhail, S. M., O'Rourke, Peter, Ballard, Emma, Irvine, K. M. and Powell, E. E. (2014) Burden of decompensated cirrhosis and ascites on hospital services in a tertiary care facility: time for change?. Internal Medicine Journal, 44 9: 865-872. doi:10.1111/imj.12491

Author Fagan, K. J.
Zhao, Eileen Y.
Horsfall, L. U.
Ruffin, Brittany J.
Kruger, Mark S.
McPhail, S. M.
O'Rourke, Peter
Ballard, Emma
Irvine, K. M.
Powell, E. E.
Title Burden of decompensated cirrhosis and ascites on hospital services in a tertiary care facility: time for change?
Journal name Internal Medicine Journal   Check publisher's open access policy
ISSN 1444-0903
Publication date 2014-09
Sub-type Article (original research)
DOI 10.1111/imj.12491
Open Access Status
Volume 44
Issue 9
Start page 865
End page 872
Total pages 8
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Collection year 2015
Language eng
Formatted abstract
Background Ascites, the most frequent complication of cirrhosis, is associated with poor prognosis and reduced quality of life. Recurrent hospital admissions are common and often unplanned, resulting in increased use of hospital services.

Aims To examine use of hospital services by patients with cirrhosis and ascites requiring paracentesis, and to investigate factors associated with early unplanned readmission.

Methods A retrospective review of the medical chart and clinical databases was performed for patients who underwent paracentesis between October 2011 and October 2012. Clinical parameters at index admission were compared between patients with and without early unplanned hospital readmissions.

Results The 41 patients requiring paracentesis had 127 hospital admissions, 1164 occupied bed days and 733 medical imaging services. Most admissions (80.3%) were for management of ascites, of which 41.2% were unplanned. Of those eligible, 69.7% were readmitted and 42.4% had an early unplanned readmission. Twelve patients died and nine developed spontaneous bacterial peritonitis. Of those eligible for readmission, more patients died (P = 0.008) and/or developed spontaneous bacterial peritonitis (P = 0.027) if they had an early unplanned readmission during the study period. Markers of liver disease, as well as haemoglobin (P = 0.029), haematocrit (P = 0.024) and previous heavy alcohol use (P = 0.021) at index admission, were associated with early unplanned readmission.

Conclusion Patients with cirrhosis and ascites comprise a small population who account for substantial use of hospital services. Markers of disease severity may identify patients at increased risk of early readmission. Alternative models of care should be considered to reduce unplanned hospital admissions, healthcare costs and pressure on emergency services.
Keyword Paracentesis
Chronic liver disease
Spontaneous bacterial peritonitis
Hospital readmission
Models of care
Healthcare cost
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 3 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 4 times in Scopus Article | Citations
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Created: Sun, 14 Sep 2014, 10:45:25 EST by Dr Katharine Irvine on behalf of Medicine - Princess Alexandra Hospital