Hospitalization for Complications of Cirrhosis: Does Volume Matter
Department of Surgery
Medical Subject Headings
Liver Cirrhosis; Patient Admission; Outcome and Process Assessment (Health Care); Hospitals; Hospitalization
INTRODUCTION: Close to 30,000 people die of cirrhosis in the USA each year. Previous studies have shown a survival advantage with high-volume (HV) hospitals for complex surgical procedures. We examined whether a volume benefit exists for hospitals dealing with specialized disorders like complications of cirrhosis.
METHODS: Using the Nationwide Inpatient Sample, we identified all cases of cirrhosis-related complications (n = 217,948) from 1998 to 2006. Hospital volume was divided into tertile-based admissions for cirrhosis per year.
RESULTS: The primary outcome was in-hospital mortality, and secondary endpoints included length of stay (LOS) and hospital charges. The number of admissions for cirrhosis increased over time (p < 0.0001). HV centers were more likely to be large (86.8%) and teaching (81.5%) hospitals compared to lower volume centers. The average LOS and hospital charges were greater at the HV centers, but hospitalization at a HV center resulted in an adjusted mortality benefit (HR 0.88; 95% CI 0.83-0.92) compared to care at lower volume hospitals.
CONCLUSION: Despite increased LOS and hospital cost, a mortality benefit exists at HV centers. Future studies are necessary to determine other processes of care that may exist at HV centers that may account for this survival benefit.
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Citation: J Gastrointest Surg. 2011 Feb;15(2):330-5. Epub 2010 Nov 25. Link to article on publisher's site