Predictors of early readmission to hospital and mortality in patients with malignant ascites: Analysis of the nationwide readmissions database.

Abstract

12057 Background: Malignant ascites accounts for 7 percent of ascites cases in the United States. It is a common manifestation of several solid tumors and is associated with poor prognosis with median survival of 3 months. Moreover, patients with malignant ascites are at risk of recurrent hospitalizations. Hospital readmissions are costly for health-care system and are regarded as a quality of care index. Nevertheless, predictive factors for hospital readmissions and mortality in patients with malignant ascites are limited. Understanding these factors can expedite development of strategies to reduce the readmission and health-care costs. Methods: Utilizing the Nationwide Readmissions Database (NRD), we conducted a retrospective cohort study on patients admitted with malignant ascites between 2016 and 2018 across the United States. We used multivariable logistic regression to determine the predictors of unplanned 30-days readmissions and mortality among patients with malignant ascites. Results: Out of 130,648 patients hospitalized with malignant ascites, 15,756 individuals (12.1%) were readmitted within next 30 days. Predictors of early readmission included pulmonary embolism (OR 2.40; 95% CI 1.55-3.74), complicated diabetes (OR 1.28; 95% CI 1.05-1.56) and having Medicaid insurance (OR 1.34; 95% CI 1.11-1.62). In-hospital mortality for patients with malignant ascites was 14.1%. The comorbidities associated with increased mortality were liver disease (OR 1.87; 95% CI 1.77-1.97), pulmonary embolism (OR 1.60; 95% CI 1.34-1.90), renal failure (OR 1.39; 95% CI 1.27-1.52), and congestive heart failure (OR 1.27; 95% CI 1.16-1.38). Patients with Medicaid insurance also had higher mortality (OR 1.21; 95% CI 1.12-1.32) among the payers. Conclusions: One in eight patients with malignant ascites was readmitted to the hospital within 30 days of discharge. By examining the risk factors leading to readmission, this study helped to identify the subpopulations of patients likely to become more ill. The strong association of pulmonary embolism with readmission and in hospital mortality suggests the benefit of prophylactic anticoagulation. Furthermore, higher readmission and mortality rate within Medicaid insurance population can open a new window in studying health care disparities.