Evaluating the Impact of Early Palliative Care Consultation on 30-Day and 90-Day Readmissions Among Patients With Decompensated Cirrhosis A National Perspective

Introduction: Decompensated cirrhosis leads to recurrent hospitalizations among patients with chronic liver disease. Addressing goals of care early can help alleviate stress, reduce health care utilization and potentially improve quality of life in these patients. Research has shown that palliative care (PC) is used infrequently and often too late in decompensated cirrhosis. Moreover, patients with cirrhosis who are denied a liver transplant are rarely referred to PC. We investigated the impact of PC consultations on unplanned readmissions among patients with decompensated cirrhosis in a nationally representative cohort. Methods: The National Readmission Database was queried from 2010 to 2019 for patients with decompensated cirrhosis using corresponding International Classification of Diseases, 10th edition codes. Patients were categorized by whether they received PC consultation during their index admission. Multivariable, hierarchical logistic regression was conducted to assess factors of receiving PC and unplanned 30-day and 90-day readmissions. Results: Among 1,630,819 patients with decompensated cirrhosis, 121,400 (7.4%) received PC consultation at index admission. Patients had higher odds of receiving PC consultations with increasing age (OR: 1.026), comorbidities such as congestive heart failure (OR: 1.172), renal failure (OR: 1.31), metastatic cancer (OR: 2.82), solid tumors without metastasis (OR: 2.37), and alcohol use disorder (OR: 1.34) (P < 0.001). Moreover, patients who received PC consultations had significantly lower odds of unplanned 30-day (OR: 0.337) and 90-day (OR: 0.268) readmissions compared with patients without (P < 0.001). Conclusion: PC consultation was associated with lower odds of unplanned 30-day and 90-day readmission among patients with decompensated cirrhosis. Because patients with multiple comorbidities were most likely to receive PC, earlier and broader engagement of PC may further alleviate stress and improve outcomes in this high-risk population.