Variation among United States hospitals in inpatient mortality for cirrhosis

Jessica L. Mellinger, Caroline R. Richardson, Amit Mathur, Michael L. Volk

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

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 by 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 U.S. Nationwide Inpatient Sample to identify patients with cirrhosis, which were based on the International Classification of Diseases, 9th Revision-Clinical Modification diagnosis codes for cirrhosis or 1 of its complications (ascites, hepatorenal syndrome, upper gastrointestinal bleeding, portal hypertension, or hepatic encephalopathy). Multilevel modeling was performed to measure variance among hospitals. Results: There were 102,155 admissions for cirrhosis in 2009, compared with 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). Multilevel 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 U.S. hospitals. Further research is needed to identify hospital-level and provider-level practices that could be modified to improve outcomes.

Original languageEnglish (US)
Pages (from-to)577-584
Number of pages8
JournalClinical Gastroenterology and Hepatology
Volume13
Issue number3
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

Fingerprint

State Hospitals
Inpatients
Fibrosis
Odds Ratio
Mortality
Hepatic Encephalopathy
Hepatorenal Syndrome
Hemorrhage
Alcoholic Liver Diseases
Portal Hypertension
International Classification of Diseases
Hospital Mortality
Ascites
Patient Care
Logistic Models
Delivery of Health Care
Transplants
Liver
Research

Keywords

  • Chronic liver disease
  • NIS
  • Regional variation
  • Survival

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Variation among United States hospitals in inpatient mortality for cirrhosis. / Mellinger, Jessica L.; Richardson, Caroline R.; Mathur, Amit; Volk, Michael L.

In: Clinical Gastroenterology and Hepatology, Vol. 13, No. 3, 01.03.2015, p. 577-584.

Research output: Contribution to journalArticle

Mellinger, Jessica L. ; Richardson, Caroline R. ; Mathur, Amit ; Volk, Michael L. / Variation among United States hospitals in inpatient mortality for cirrhosis. In: Clinical Gastroenterology and Hepatology. 2015 ; Vol. 13, No. 3. pp. 577-584.
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abstract = "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 by 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 U.S. Nationwide Inpatient Sample to identify patients with cirrhosis, which were based on the International Classification of Diseases, 9th Revision-Clinical Modification diagnosis codes for cirrhosis or 1 of its complications (ascites, hepatorenal syndrome, upper gastrointestinal bleeding, portal hypertension, or hepatic encephalopathy). Multilevel modeling was performed to measure variance among hospitals. Results: There were 102,155 admissions for cirrhosis in 2009, compared with 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). Multilevel 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 U.S. hospitals. Further research is needed to identify hospital-level and provider-level practices that could be modified to improve outcomes.",
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