Preventable Visits to the Emergency Department in Patients with Cirrhosis

Background/Aims: Emergency department (ED) utilization is a major driver of healthcare costs in cirrhosis, yet the burden of preventable ED visits (EDVs) is understudied. We aimed to estimate the prevalence of potentially preventable EDVs, associated clinical factors, and outcomes. Methods: In a retrospective cohort study of adults with cirrhosis presenting to a statewide health system in 2021, 2,124 index EDVs were adjudicated for preventability using predefined cirrhosis-specific criteria (preventable with urgent hepatology evaluation, urgent paracentesis, expanded hours of outpatient access, or outpatient medication optimization). LASSO variable selection followed by multivariable logistic regression identified factors independently associated with preventable EDVs. Results: Overall, 15% (n=317) of index ED visits were potentially preventable with an urgent hepatology follow-up (45%), paracentesis access (33%), and outpatient medication management (31%). Compared with non-preventable visits, preventable EDVs had lower 90-day mortality (10% vs 17%; p=0.001) but higher 90-day ED revisits (50% vs 41%; p=0.003). In multivariable analysis, key patient factors associated with preventable EDVs were active alcohol use (aOR 3.05, 95%CI:1.03-9.01, p=0.044), lack of access to primary care (aOR 5.40, 95%CI:1.79 -16.30, p=0.003), and uncontrolled ascites at time of EDV (aOR 2.19, 95%CI:1.45-3.32, p<0.001). A discharge diagnosis of ascites was associated with a preventable EDV (aOR 2.05, 95%CI:1.29-3.25, p=0.002) while diagnoses of GI bleed, electrolyte disorders, infections and non-liver related diagnosis were not associated with preventable EDVs. Conclusions: Potentially preventable EDVs represent 1 in 6 EDVs and are frequently related to timely outpatient specialty access and ascites management suggesting that targeted outpatient care redesign may reduce cirrhosis-related acute healthcare use.