Variation Among US hospitals in Inpatient Mortality for Cirrhosis.
Clin Gastroenterol Hepatol. 2014 Sep 25;
Authors: Mellinger JL, Richardson CR, Mathur AK, Volk ML
BACKGROUND & AIMS: Little is known about geographic variations in health care for patients with cirrhosis. We studied geographic and hospital-level variations in care of patients with cirrhosis in the United States (US), using inpatient mortality as an outcome for comparing hospitals. We also aimed to identify features of patients and hospitals associated with lower mortality.
METHODS: We used the 2009 US Nationwide Inpatient Sample to identify patients with cirrhosis, based on ICD-9-CM diagnosis codes for cirrhosis or 1 of its complications (ascites, hepatorenal syndrome, upper gastrointestinal bleeding, portal hypertension, or hepatic encephalopathy). Multi-level modeling was performed to measure variance among hospitals.
RESULTS: There were 102,155 admissions for cirrhosis in 2009, compared to 74,417 in 2003. Overall inpatient mortality was 6.6%. On multivariable-adjusted logistic regression, patients hospitalized in the Midwest had the lowest odds ratio (OR) of inpatient mortality (OR, 0.54; P<.001). Patients who were transferred from other hospitals (OR, 1.49; P<.001) or had hepatic encephalopathy (OR, 1.28; P<.001), upper gastrointestinal bleeding (OR, 1.74; P<.001), or alcoholic liver disease (OR, 1.23; P=.03) had higher odds of inpatient mortality than patients without these features. Those who received liver transplants had substantially lower odds of inpatient mortality (OR, 0.21; P<.001). Multi-level modeling showed that 4% of the variation in mortality could be accounted for at the hospital level (P<.001). Adjusted mortality among hospitals ranged from 1.2% to 14.2%.
CONCLUSIONS: Inpatient cirrhosis mortality varies considerably among US hospitals. Further research is needed to identify hospital- and provider-level practices that could be modified to improve outcomes.
PMID: 25264271 [PubMed - as supplied by publisher]