Hospitalization for Complications of Cirrhosis: Does Volume Matter

UMMS Affiliation

Department of Surgery

Publication Date


Document Type



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.

DOI of Published Version



J Gastrointest Surg. 2011 Feb;15(2):330-5. Epub 2010 Nov 25. Link to article on publisher's site

Journal/Book/Conference Title

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract


Medical student Anand Singla participated in this study as part of the Senior Scholars research program at the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID