An Advanced Practice Practitioner–Based Program to Reduce 30‐ and 90‐Day Readmissions After Liver Transplantation

Abstract

Hospital readmissions after liver transplantation (LT) are common and associated with increased morbidity and cost. High readmission rates at our center motivated a change in practice with adoption of a nurse practitioner (NP)–based posttransplant care program. We sought to determine if this program was effective in reducing 30‐ and 90‐day readmissions after LT and to identify variables associated with readmission. We performed a retrospective cohort study of all patients undergoing LT from July 1, 2014, to June 30, 2017, at a tertiary LT referral center. A NP‐based posttransplant care program with weekend in‐house nurse coordination providers and increased outpatient NP clinic availability was instituted on January 1, 2016. Postdischarge readmission rates at 30 and 90 days were compared in the pre‐exposure and postexposure groups, adjusting for associated risk factors. A total of 362 patients were included in the analytic cohort. There were no significant differences in demographics, comorbidities, or index hospitalization characteristics between groups. In the adjusted analyses, the risk of readmission in the postexposure group was significantly reduced relative to baseline at 30 days (hazard ratio [HR] 0.60, 95% confidence interval [CI], 0.39‐0.90; P = 0.02) and 90 days (HR, 0.49; 95% CI, 0.34‐0.71; P < 0.001). Risk factors positively associated with 30‐day readmission included peritransplant dialysis (HR, 1.70; 95% CI, 1.13‐2.58; P = 0.01) and retransplant on index hospitalization (HR, 10.21; 95% CI, 3.39‐30.75; P < 0.001). Male sex was protective against readmission (HR, 0.66; 95% CI, 0.45‐0.97; P = 0.03). In conclusion, implementation of expanded NP‐based care after LT was associated with significantly reduced 30‐ and 90‐day readmission rates. LT centers and other service lines using significant postsurgical resources may be able to reduce readmissions through similar programs.