S2284 Hospitalization Costs for 30-Day vs 6-Month Readmissions for ERCP After Liver Transplant

Introduction: The Affordable Care Act (ACA) mandates public reporting of 30 day hospital readmission rates for several medical and surgical conditions in order to assess and implement penalties in hospitals with increased readmission rates. Readmissions following liver transplants (LT) are not a part of this program, despite increased associated financial burden and patient mortality. Our study assesses the mean cost of hospital readmissions due to endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone LT between patients readmitted within 30 days and 6 months. Methods: This project used the National Readmission Database (NRD) to identify patients who were readmitted to the hospital for ERCP within 6 months of LT between 2016 to 2019. Patients less than 18 years of age and/or undergoing elective ERCP were excluded. Patient characteristics were found using ICD-10 codes. The primary outcome was the incidence of ERCP following LT with characterization by gender, age and Charlson comorbidity index (CCI). Readmission risk based on patient insurance was also assessed as a secondary outcome. Results: The average readmission cost of all patients receiving ERCP following LT was $131,016. There was no significant difference between gender, age, and CCI subgroups between both 30-day and 6-month patients. However, the cost of readmissions for 6-month patients was significantly cheaper than 30-day patients (P < 0.001). Conclusion: Our study finds that the overall cost of readmissions for 6-month patients was significantly cheaper than 30-day patients. Although the most common biliary complication within 6 months are strictures, current literature is limited in analyzing the complications of 6 month readmissions for ERCP after LT and their respective costs. To further clarify the cause of the elevated costs of readmissions at 30 days, future studies should examine known independent predictors for readmission in LT patients such as length of stay, infection, liver biopsy, and hemodialysis use during index admission.