Skip to main content

Hospitalization for Complications of Cirrhosis: Does Volume Matter?

Journal of Gastrointestinal Surgery volume 15, pages 330–335 (2011)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

39,95 €

Price includes VAT (Netherlands)

Fig. 1

References

  1. Nguyen GC, Segev DL, Thuluvath PJ. Nationwide increase in hospitalizations and hepatitis C among inpatients with cirrhosis and sequelae of portal hypertension. Clin Gastroenterol Hepatol 2007; 5:1092–1099.

    Article  PubMed  Google Scholar 

  2. Freeman RB, Jr., Wiesner RH, Harper A et al. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl 2002; 8:851–858.

    Article  PubMed  Google Scholar 

  3. Merion RM, Schaubel DE, Dykstra DM et al. The survival benefit of liver transplantation. Am J Transplant 2005; 5:307–313.

    Article  PubMed  Google Scholar 

  4. Sorensen HT, Thulstrup AM, Mellemkjar L et al. Long-term survival and cause-specific mortality in patients with cirrhosis of the liver: a nationwide cohort study in Denmark. J Clin Epidemiol 2003; 56:88–93.

    Article  PubMed  Google Scholar 

  5. Csikesz NG, Tseng JF, Shah SA. Trends in surgical management for acute cholecystitis. Surgery 2008; 144:283–289.

    Article  PubMed  Google Scholar 

  6. Csikesz NG, Simons JP, Tseng JF et al. Surgical specialization and operative mortality in hepato-pancreatico-biliary (HPB) surgery. J Gastrointest Surg 2008; 12:1534–1539.

    Article  PubMed  Google Scholar 

  7. Elixhauser A, Steiner C, Harris DR et al. Comorbidity measures for use with administrative data. Med Care 1998; 36:8–27.

    Article  CAS  PubMed  Google Scholar 

  8. Fry DE, Pine M, Jordan HS et al. Combining administrative and clinical data to stratify surgical risk. Ann Surg 2007; 246:875–885.

    Article  PubMed  Google Scholar 

  9. Myers RP, Papay KD, Shaheen AA et al. Relationship between hospital volume and outcomes of esophageal variceal bleeding in the United States. Clin Gastroenterol Hepatol 2008; 6:789–798.

    Article  PubMed  Google Scholar 

  10. El Serag HB. Epidemiology of hepatocellular carcinoma in USA. Hepatol Res 2007; 37 Suppl 2:S88–S94

    Article  PubMed  Google Scholar 

  11. Csikesz NG, Nguyen LN, Tseng JF et al. Nationwide volume and mortality after elective surgery in cirrhotic patients. J Am Coll Surg 2009; 208:96–103.

    Article  PubMed  Google Scholar 

  12. Birkmeyer JD, Siewers AE, Finlayson EV et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002; 346:1128–1137.

    Article  PubMed  Google Scholar 

  13. Eppsteiner RW, Csikesz NG, Simons JP et al. High volume and outcome after liver resection: surgeon or center? J Gastrointest Surg 2008; 12:1709–1716.

    Article  PubMed  Google Scholar 

  14. McPhee JT, Hill JS, Whalen GF et al. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg 2007; 246:246–253.

    Article  PubMed  Google Scholar 

  15. Axelrod DA, Guidinger MK, McCullough KP et al. Association of center volume with outcome after liver and kidney transplantation. Am J Transplant 2004; 4:920–927.

    Article  PubMed  Google Scholar 

  16. Rosenthal GE, Baker DW, Norris DG et al. Relationships between in-hospital and 30-day standardized hospital mortality: implications for profiling hospitals. Health Serv Res 2000; 34:1449–1468.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, 55 Lake Avenue North, S6-432, Worcester, MA, 01655, USA

    Anand Singla, James L. Hart, YouFu Li, Jennifer F. Tseng & Shimul A. Shah

Authors
  1. Anand Singla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James L. Hart
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. YouFu Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer F. Tseng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shimul A. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shimul A. Shah.

Additional information

Anand Singla and James L. Hart are co-first authors.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Singla, A., Hart, J.L., Li, Y. et al. Hospitalization for Complications of Cirrhosis: Does Volume Matter?. J Gastrointest Surg 15, 330–335 (2011). https://doi.org/10.1007/s11605-010-1398-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-010-1398-1

Keywords

  • Cirrhosis
  • Volume
  • NIS
  • Hospitalizations
  • Length of stay