RESOURCE UTILIZATION, COST, AND UNPLANNED READMISSIONS ASSOCIATED WITH HEPATORENAL SYNDROME FROM THE UNITED STATES (US) HOSPITAL PERSPECTIVE: 2009-2015

• Published in: Value in health Vol. 20; no. 5; p. 217
• Main Authors: Pham, AT, Jamil, K, Huang, X, Lodaya, K, Hayashida, DK, Lovelace, B
• Format: Journal Article
• Language: English
• Published: Lawrenceville Elsevier Science Ltd 01-05-2017
• Subjects: Clinical outcomes; Creatinine; Data processing; Electronic medical records; Health care expenditures; Health services utilization; Help seeking behavior; Hospitalization; Kidney diseases; Liver diseases; Mortality; Mortality rates; Patient admissions; Patients; Readmission; Renal failure; Resource utilization; Serum; United States > US
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.05.005

OBJECTIVES: Hepatorenal Syndrome (HRS), the development of functional renal failure in patients with advanced chronic liver disease, is associated with high cost of patient care. The objective of this study was to examine total health care resource utilization, cost of care and outcomes, including mortality and read-mission from US hospital perspective. METHODS: A retrospective, longitudinal analysis of the CERNER Health Facts k electronic health record (EHR) database was performed. Adult patients diagnosed with HRS based on ICD-9 code (572.4) between 2009 and 2015 were included in the analysis. Clinical data including serum creatinine were used to assess outcomes. RESULTS: We identified 1,571 male (62%) and 971 female (38%) patients (mean age: 57.9). The median cost for all patients was $22,911. The highest median cost associated with HRS was in patients between 18 and 35 years old. Overall, female patients incurred higher costs than males. The highest incidence of HRS was in 2013 with -19% of all cases from 2009 to 2015 and the highest average cost per patient was in 2009 with $38,778. HRS mortality rate was 36.8% during initial hospitalization, and median cost of hospitalization was higher for deceased vs. surviving patients ($24,667 vs. $21,360). HRS readmission rate was 17.62%, with 10.62% planned and 7.32% unplanned readmission. Unplanned readmissions were associated with higher median costs ($31,946 vs. $17,357). CONCLUSIONS: From a hospital perspective, results from this analysis of large US hospital EHR database indicate that HRS is a very severe disease with high mortality. Managing patients with HRS is associated with high burden in resource utilization, cost-of-care, and especially around the unplanned readmissions, which presents a potential opportunity for improvement.