Determinants of early readmission following liver transplantation: A National analysis of the TransQIP database

BACKGROUND: Thirty-day readmission after liver transplantation (LT) is a key quality metric associated with early morbidity, increased healthcare utilization, and worse long-term outcomes. Most reported readmission rates range from 25-46%, yet predictors remain inconsistently defined due to reliance on administrative data or single-center cohorts. METHODS: We performed a retrospective cohort study of adult deceased donor LT recipients in the prospectively-collected American College of Surgeons National Surgical Quality Improvement Program-Transplant (TransQIP) registry from 3/2017 to 12/2019. The primary outcome was unplanned hospital readmission within 30 days of discharge. We characterized the incidence, timing, and causes of readmission and identified independent predictors. Multivariable logistic regression was used to identify independent predictors of readmission. RESULTS: Among 1,164 recipients, 497 were readmitted within 30 days (43%). 30-day readmissions were typically brief, with a median length of stay of 4 days (IQR 2-8). LT-specific procedural interventions occurred in 147 readmitted patients (29.6%), indicating that most readmissions were driven by non-procedural medical complications. In multivariable analysis, post-discharge organ-space surgical site infection (OR 61.0, 95% CI 8.2-458, p<0.001), post-discharge sepsis (OR 9.9, 95% CI 1.1-91, p=0.047), and post-discharge urinary tract infection (OR 4.7, 95% CI 1.7-13.0, p=0.030) were the strongest predictors of readmission. Protective factors included functional status ≥70% (OR 0.74, 95% CI 0.56-0.97, p=0.030). Exploratory analyses identified distinct risk profiles for post-discharge UTI and organ-space SSI. CONCLUSION: Thirty-day readmission after LT is common, occurs early after discharge, and is driven by post-discharge infectious complications, specifically UTI and organ space SSI. Functional status is independently protective. These findings highlight actionable targets to reduce early readmissions after liver transplantation.