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

Aya Akhras, MD¹, Saadia Nabi, MD¹, Luis Santiago Zayas, MD¹, Kristen Santana, MD¹, Mohammed Akram, MD¹, Mahesh Tummala, MD¹, Carmen Tormo Carrillo, MD¹, Waseem Wahood, MD, MS², Sinay Ceballos, MD¹, Deannys Batista, MD¹, Alisha Menon, MD¹, Bernardo Reyes, MD¹, Franklin Kasmin, MD^1
1HCA Florida Aventura Hospital and Medical Center, Aventura, FL; ²University of Miami Miller School of Medicine at Jackson Memorial Hospital, Miami, FL

Introduction: Decompensated cirrhosis is a cause of morbidity and mortality among patients with chronic liver disease. The number of hospitalizations for this condition is increasing annually. Addressing goals of care early can help alleviate stress, reduce healthcare utilization and potentially improve quality of life in these patients. Research has shown that palliative care is used infrequently and often too late in decompensated cirrhosis. Moreover, patients with cirrhosis who are denied liver transplant are rarely referred to palliative care. We investigated the impact of palliative care consultations on unplanned readmissions among patients with decompensated cirrhosis in a nationally representative cohort.

Methods: The National Readmission Database was queried from 2010-2019 for patients with cirrhosis. We included patients with decompensated cirrhosis were further identified using corresponding International Classification of Diseases, 10th edition codes. Patients were then identified by whether they received palliative care consultation during their index admission. Multivariable, hierarchical logistic regression was conducted to assess factors of receiving palliative care and unplanned 30- and 90-day readmissions.

Results: There were a total of 1,630,819 patients admitted with decompensated cirrhosis between 2010-2019. Of these, 121,400 (7.4%) received a palliative care consultation at index admission. Patients had higher odds of receiving palliative care consultations with increasing age (OR 1.026), had other comorbidities including 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 palliative care consultations had significantly lower odds of unplanned 30-day (OR 0.337) and 90-day (OR 0.268) readmissions compared to patients without (p< 0.001).

Discussion: Palliative care consultation was associated with lower odds of unplanned 30- and 90-day readmission among patients with decompensated cirrhosis. Patients with high comorbid burden were more likely to receive a Palliative Consultation. Healthcare professionals should consider engagement of palliative care consultations early based on these encouraging results, which can help alleviate stress, and improve quality of life in this patient population.




Disclosures:


Aya Akhras, MD¹, Saadia Nabi, MD¹, Luis Santiago Zayas, MD¹, Kristen Santana, MD¹, Mohammed Akram, MD¹, Mahesh Tummala, MD¹, Carmen Tormo Carrillo, MD¹, Waseem Wahood, MD, MS², Sinay Ceballos, MD¹, Deannys Batista, MD¹, Alisha Menon, MD¹, Bernardo Reyes, MD¹, Franklin Kasmin, MD¹, 61, Evaluating the Impact of Palliative Care Consultation on 30- and 90-Day Readmissions Among Patients With Decompensated Cirrhosis: A National Perspective, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.