Advertisement
ORIGINAL RESEARCH| Volume 103, ISSUE 9, P1730-1737, September 2022

Effects of In-Hospital Rehabilitation on Preventing Hospital Readmissions in Patients With Cirrhosis: A Retrospective Cohort Study

Published:January 05, 2022DOI:https://doi.org/10.1016/j.apmr.2021.12.009

      Highlights

      • This study aimed to investigate the effect of rehabilitation on hospital readmissions in cirrhotic patients.
      • The present study demonstrated that rehabilitation is associated with lower proportions of 30- and 90-day readmissions in patients with cirrhosis.
      • Rehabilitation may be one way to reduce the risk of readmission in patients hospitalized for cirrhosis.

      Abstract

      Objectives

      To investigate the effect of rehabilitation on hospital readmissions in patients with cirrhosis.

      Design

      A retrospective cohort study.

      Setting

      Acute hospitals.

      Participants

      Patients hospitalized due to cirrhosis (N=6485).

      Interventions

      We defined rehabilitation as any type and intensity of rehabilitation administered by physical, occupational, or speech therapists.

      Main Outcome Measures

      Readmission within 30 days after discharge.

      Results

      Rehabilitation was provided to 1177 patients (19.0%). After propensity score matching, rehabilitation was associated with 30- and 90-day readmissions.

      Conclusions

      The present study demonstrated that rehabilitation is associated with lower proportions of 30- and 90-day readmissions in patients with cirrhosis. Therefore, rehabilitation may be one way to reduce the risk of readmission in patients hospitalized for cirrhosis.

      Keywords

      List of abbreviations:

      DPC (Diagnosis Procedure Combination), HR (hazard ratio), JMDC (Japan Medical Data Center), LOS (length of stay), MI (multiple imputation), RR (risk ratio)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • D'Amico G
        • Garcia-Tsao G
        • Pagliaro L.
        Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies.
        J Hepatol. 2006; 44: 217-231
        • Nguyen GC
        • Segev DL
        • Thuluvath PJ.
        Nationwide increase in hospitalizations and hepatitis C among inpatients with cirrhosis and sequelae of portal hypertension.
        Clin Gastroenterol Hepatol. 2007; 5: 1092-1099
        • Covinsky KE
        • Pierluissi E
        • Johnston CB.
        Hospitalization-associated disability: “She was probably able to ambulate, but I'm not sure.
        JAMA. 2011; 306: 1782-1793
      1. LaW. MoH. Patient survey. Available at: https://www.mhlw.go.jp/toukei/list/10-20.html. Accessed February 12, 2021.

        • Toyokawai S
        • Kobayashi Y
        • Ohmori M.
        Refined method for estimating medical expenditures for liver disease using the patient survey and claim data in Japan.
        Nihon Koshu Eisei Zasshi. 2005; 52: 957-961
        • Volk ML
        • Tocco RS
        • Bazick J
        • Rakoski MO
        • Lok AS.
        Hospital readmissions among patients with decompensated cirrhosis.
        Am J Gastroenterol. 2012; 107: 247-252
        • Seraj SM
        • Campbell EJ
        • Argyropoulos SK
        • Wegermann K
        • Chung RT
        • Richter JM.
        Hospital readmissions in decompensated cirrhotics: factors pointing toward a prevention strategy.
        World J Gastroenterol. 2017; 23: 6868-6876
        • Fisher SR
        • Graham JE
        • Krishnan S
        • Ottenbacher KJ.
        Predictors of 30-day readmission following inpatient rehabilitation for patients at high risk for hospital readmission.
        Phys Ther. 2016; 96: 62-70
        • Agrawal K
        • Kumar P
        • Markert R
        • Agrawal S.
        Risk factors for 30-day readmissions of individuals with deompensated cirrhosis.
        South Med J. 2015; 108: 682-687
        • Winstein CJ
        • Stein J
        • Arena R
        • et al.
        Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2016; 47: e98-169
        • Balady GJ
        • Williams MA
        • Ades PA
        • et al.
        Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation.
        Circulation. 2007; 115: 2675-2682
        • Ries AL
        • Bauldoff GS
        • Carlin BW
        • et al.
        Pulmonary rehabilitation: Joint ACCP/AACVPR evidence-based clinical practice guidelines.
        Chest. 2007; 131: 4s-42s
        • Meza-Junco J
        • Montano-Loza AJ
        • Baracos VE
        • et al.
        Sarcopenia as a prognostic index of nutritional status in concurrent cirrhosis and hepatocellular carcinoma.
        J Clin Gastroenterol. 2013; 47: 861-870
        • Montano-Loza AJ
        • Meza-Junco J
        • Baracos VE
        • et al.
        Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation.
        Liver Transpl. 2014; 20: 640-648
        • Masuda T
        • Shirabe K
        • Ikegami T
        • et al.
        Sarcopenia is a prognostic factor in living donor liver transplantation.
        Liver Transpl. 2014; 20: 401-407
        • van Vugt JL
        • Levolger S
        • de Bruin RW
        • van Rosmalen J
        • Metselaar HJ
        • IJ JN
        Systematic review and meta-analysis of the impact of computed tomography-assessed skeletal muscle mass on outcome in patients awaiting or undergoing liver transplantation.
        Am J Transplant. 2016; 16: 2277-2292
        • Krell RW
        • Kaul DR
        • Martin AR
        • et al.
        Association between sarcopenia and the risk of serious infection among adults undergoing liver transplantation.
        Liver Transpl. 2013; 19: 1396-1402
        • Norman K
        • Kirchner H
        • Lochs H
        • Pirlich M.
        Malnutrition affects quality of life in gastroenterology patients.
        World J Gastroenterol. 2006; 12: 3380-3385
        • Tapper EB
        • Halbert B
        • Mellinger J.
        Rates of and reasons for hospital readmissions in patients with cirrhosis: a multistate population-based cohort study.
        Clin Gastroenterol Hepatol. 2016; 14 (1181-8.e1182)
        • Dhoble A
        • Bhise V
        • Nevah MI
        • et al.
        Outcomes and readmissions after transcatheter and surgical aortic valve replacement in patients with cirrhosis: a propensity matched analysis.
        Catheter Cardiovasc Interv. 2018; 91: 90-96
        • Yoshiji H
        • Nagoshi S
        • Akahane T
        • et al.
        Evidence-based clinical practice guidelines for liver cirrhosis 2020.
        J Gastroenterol. 2021; 56: 593-619
        • Rubin DB
        • Schenker N.
        Multiple imputation in health-care databases: an overview and some applications.
        Stat Med. 1991; 10: 585-598
        • Aloisio KM
        • Swanson SA
        • Micali N
        • Field A
        • Horton NJ.
        Analysis of partially observed clustered data using generalized estimating equations and multiple imputation.
        Stata J. 2014; 14: 863-883
        • Austin PC.
        Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.
        Pharm Stat. 2011; 10: 150-161
        • Austin PC.
        An introduction to propensity score methods for reducing the effects of confounding in observational studies.
        Multivariate Behav Res. 2011; 46: 399-424
        • Austin PC.
        Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.
        Stat Med. 2009; 28: 3083-3107
        • Zenith L
        • Meena N
        • Ramadi A
        • et al.
        Eight weeks of exercise training increases aerobic capacity and muscle mass and reduces fatigue in patients with cirrhosis.
        Clin Gastroenterol Hepatol. 2014; 12 (1920-6.e1922)
        • Román E
        • García-Galcerán C
        • Torrades T
        • et al.
        Effects of an exercise programme on functional capacity, body composition and risk of falls in patients with cirrhosis: a randomized clinical trial.
        PLoS One. 2016; 11e0151652
        • Matsui H
        • Jo T
        • Fushimi K
        • Yasunaga H
        Outcomes after early and delayed rehabilitation for exacerbation of chronic obstructive pulmonary disease: a nationwide retrospective cohort study in Japan.
        Respir Res. 2017; 18: 68
        • Sawabe M
        • Hasebe K
        • Momosaki R.
        Effectiveness of early versus delayed physical rehabilitation on in-hospital mortality in interstitial pneumonia: a retrospective cohort study.
        PM R. 2020; 12: 1081-1085
        • Duarte-Rojo A
        • Ruiz-Margáin A
        • Montaño-Loza AJ
        • Macías-Rodríguez RU
        • Ferrando A
        • Kim WR.
        Exercise and physical activity for patients with end-stage liver disease: Improving functional status and sarcopenia while on the transplant waiting list.
        Liver Transpl. 2018; 24: 122-139
        • Inokuchi H
        • Yasunaga H
        • Nakahara Y
        • et al.
        Effect of rehabilitation on mortality of patients with Guillain-Barre syndrome: a propensity-matched analysis using nationwide database.
        Eur J Phys Rehabil Med. 2014; 50: 439-446