National trends and predictors of 90-day all-cause readmission in hepatocellular carcinoma: A real-world outcomes study using the Nationwide Readmissions Database.

Abstract

491 Background: Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and the third leading cause of cancer related mortality. Outcomes are often shaped not only by the cancer itself but also by the burden of underlying cirrhosis and treatment related complications. Hospitalizations are common and carry substantial costs, driven by both disease progression and liver decompensation. This study examines resource use and the leading causes of 90-day readmissions after HCC admissions. Methods: We conducted a retrospective study using the 2022 Nationwide Readmissions Database (NRD), part of the Healthcare Cost and Utilization Project. We identified patients with Hepatocellular carcinoma who were hospitalized between January and October. The first unplanned readmission within 90 days of discharge was used to define the readmission cohort. Survey-weighted logistic, linear, and Cox regression models were used to assess clinical and hospital-level factors associated with readmission. Results: In multivariable analysis, younger age (aHR 0.99, p<0.001) and thrombocytopenia (aHR 0.92, p=0.035) were associated with lower readmission risk, while longer length of stay during index admission (aHR 1.00, p=0.005), diabetes (aHR 1.08, p=0.007), hyperlipidemia (aHR 1.09, p=0.004), ascites (aHR 1.23, p<0.001), varices (aHR 1.10, p=0.027), renal impairment (aHR 1.07, p=0.023), and treatment under 'other’ insurance payers was associated with lower risk compared with Medicare (aHR 0.79, p=0.030). Alcohol-related liver disease was protective (aHR 0.84, p<0.001). Top 90-day readmission causes were sepsis (2,181), cancer progression (1,822), cirrhosis (1,157), hepatic failure (965), acute kidney failure (504), cholangitis/biliary disorders (305), chronic pain (166), COVID-19 (145), hypertensive heart and kidney disease with heart failure (145), and pneumonia (137). Conclusions: In patients with hepatocellular carcinoma, 90-day readmissions are driven not only by tumor progression but also by sepsis and complications of portal hypertension, including ascites and varices. Metabolic comorbidities such as diabetes and hyperlipidemia further increased risk, Targeting infection prevention and better management of cirrhosis related decompensation may reduce readmissions and improve outcomes in this high-risk population. Comparative resource utilization between index hospitalizations and 90-day readmissions in patients with hepatocellular carcinoma. Category Index Admission 90-Day Readmission Weighted admissions 36,143.38 11,576.02 In-hospital deaths 3267.847 N/A Mean length of stay (days) 7.25 7.29 Mean charges (USD) $113,925 $111,415.6 Mean costs (USD) $27,787.15 $27,179.18 Cumulative hospital days 262,174.8 84,459.19 Cumulative charges (USD) $4.08 billion $1.28 billion Cumulative costs (USD) $996 million $312 million