Hospitalization for Complications of Cirrhosis: Does Volume Matter

Anand Singla, University of Massachusetts Medical School
James L. Hart, University of Massachusetts Medical School
YouFu Li, University of Massachusetts Medical School
Jennifer F. Tseng, University of Massachusetts Medical School
Shimul A. Shah, University of Massachusetts Medical School

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

Abstract

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.