Improved Outcomes of Liver Transplant Recipients Discharged to a Dedicated Inpatient Rehabilitation Facility

Abstract

Liver transplant (LT) recipients represent a population with significant medical complexity and deconditioning. The purpose of this study was to determine if discharge to an inpatient rehabilitation facility (IRF) post-LT was associated with lower readmission and mortality rates compared to discharge home. A retrospective review of LT patients at a large tertiary referral center between 2015 and 2018 was performed. Demographics, medical history, discharge location, and outcomes were compared using Mann-Whitney U and Chi-square tests. Of 146 eligible patients, 74 were discharged to IRF and 72 to home. Patients discharged to IRF had longer hospitalizations and higher MELD scores (p < 0.03) compared to those home. However, they experienced lower readmission rates (20% vs 32%, p = 0.11) and lower mortality rates (8% vs 13%, P = 0.38). Patients admitted to IRF had significant improvement on Functional Independence Measure (FIM) score at discharge compared to admission (95.9 vs 67.0, p = 0.0001). Regression analysis determined that discharge to IRF was the sole predictor of readmission (χ2(4) = 6.96, P = 0.14, Negelkerke R2 = 0.05). Patients discharged to IRF had lower rates of readmission and mortality despite greater medical complexity, underscoring the importance of rehabilitation following LT.

Keywords

• inpatient rehabilitation
• transplantation
• multidisciplinary/interdisciplinary rehabilitation
• outcomes research