Cirrhosis patients in high- vs low-burden hospitals at higher risk of death

Patients with cirrhosis hospitalized in high-burden hospitals (HBH) are 5-percent more likely to die than those in low-burden hospitals (LBH), reports a study. Moreover, Blacks with cirrhosis have 27-percent higher in-hospital mortality than Whites even after adjusting for safety-net burden.

The authors used National Inpatient Sample data from 2012 to 2016, the largest US all-payer inpatient healthcare claims database of hospital discharges, to stratify cirrhosis-related hospitalizations into tertiles of safety-net burden: HBH, LBH, and medium-burden hospitals (MBH).

Safety-net burden was calculated as percentage of hospitalizations per hospital with Medicaid or uninsured payer status. Factors associated with in-hospital mortality were assessed using multivariable logistic regression.

Of the 322,944 cirrhosis-related hospitalizations, 63.7 percent were Whites, 9.9 percent Blacks, and 15.6 percent Hispanics. The likelihood of hospitalizations in HBHs vs MBHs or LBHs were higher among Blacks (odds ratio [OR], 1.26, 95 percent confidence interval [CI], 1.17–1.35; p<0.001) and Hispanics (OR, 1.63, 95 percent CI, 1.50–1.78; p<0.001) than Whites.

Cirrhosis-related hospitalizations in MBHs or HBHs correlated with greater odds of in-hospital death relative to LBH (OR, 1.05, 95 percent CI, 1.00–1.10; p=0.044). Of note, Black patients were more likely to succumb to death in the hospital than their White counterparts (OR, 1.27, 95 percent CI, 1.21–1.34; p<0.001).

“Over 2.1 million individuals in the US have cirrhosis, including 513,000 with decompensated cirrhosis,” the authors said. “Hospitals with high safety-net burden disproportionately serve ethnic minorities and have reported worse outcomes in surgical literature.”