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Palliative medicine and hospital readmissions in end-stage liver disease
  1. Barret Rush1,
  2. Clark Fruhstofer2,
  3. Keith R Walley3,4,
  4. Leo Anthony Celi5 and
  5. Mayur Brahmania6
  1. 1 Division of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  2. 2 Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3 Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada
  4. 4 Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  5. 5 Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  6. 6 Division of Gastroenterology, Department of Medicine, London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
  1. Correspondence to Dr Barret Rush, Division of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, MB R3A 1R9, Canada; bar890{at}


Background Patients with end-stage liver disease (ESLD) have a reduced life expectancy and a significant symptom burden. Our aim is to determine if inpatient palliative care (PC) referral for patients with ESLD is associated with decreased hospital readmission rates.

Methods The 2013 US Nationwide Readmission Database (NRD) was used for the current analysis. The NRD allows for longitudinal analysis of all patient hospital admissions across 22 states. Patients ≥18 years of age with a diagnosis of ESLD with at least two decompensating events were included in the analysis. PC referral at the index hospitalisation divided the cohort into two groups, which were tracked for 9 months.

Results A total of 14 325 172 hospital admissions from the 2013 NRD were examined. In the first 3 months of 2013, a total of 3647 patients with ESLD were admitted with 206 (5.6%) receiving PC referral during the index admission. After the index hospitalisation, patients referred to PC were more likely to be discharged to skilled nursing facilities (45.5% vs 14.7%; p<0.01) or hospice/home care (32.9% vs 15.3%; p<0.01). After propensity score matching, those patients referred to PC demonstrated a significantly lower rate of 1-year hospital readmission (11.0% vs 32.1%; p<0.01).

Conclusion Inpatient PC referral for patients with ESLD was associated with lower rates of hospital readmission. Early concurrent PC referral likely has added beneficial effects beyond quality of life issues and symptom management.

  • end-stage liver disease
  • readmission
  • palliative care
  • NRD database

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  • Contributors All authors contributed to study design and writing of manuscript. BR performed the main statistical analysis. All authors were involved with revisions and updating of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.