Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2017; 23(10): 1857-1865
Published online Mar 14, 2017. doi: 10.3748/wjg.v23.i10.1857
Hospital resource intensity and cirrhosis mortality in United States
Amit K Mathur, Apurba K Chakrabarti, Jessica L Mellinger, Michael L Volk, Ryan Day, Andrew L Singer, Winston R Hewitt, Kunam S Reddy, Adyr A Moss
Amit K Mathur, Ryan Day, Andrew L Singer, Winston R Hewitt, Kunam S Reddy, Adyr A Moss, Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, United States
Amit K Mathur, Robert D and Patricia E Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Phoenix, AZ 85054, United States
Apurba K Chakrabarti, Jessica L Mellinger, Department of Medicine, University of Michigan, Ann Arbor, MI 48109, United States
Michael L Volk, Department of Medicine, Loma Linda University, Loma Linda, CA 92350, United States
Author contributions: Mathur AK, Chakrabarti AK, Mellinger JL and Volk ML designed the study and acquired the data; Mathur AK, Chakrabarti AK, Mellinger JL, Volk ML, Day R and Singer AL analyzed and interpreted the data; Mathur AK, Chakrabarti AK, Mellinger JL, Volk ML, Day R, Singer AL, Hewitt WR, Reddy KS and Moss AA drafted and performed critical revisions of the manuscript.
Institutional review board statement: The study employed data from publicly available data sources and was therefore exempt from Institutional Review Board approval at the University of Michigan.
Informed consent statement: Humans subjects were not involved in this project and so informed consent was waived.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Amit K Mathur, MD, MS, Assistant Professor, Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, United States. mathur.amit@mayo.edu
Telephone: +1-480-3420437 Fax: +1-480-3422324
Received: November 5, 2016
Peer-review started: November 8, 2016
First decision: December 19, 2016
Revised: January 4, 2017
Accepted: February 7, 2017
Article in press: February 8, 2017
Published online: March 14, 2017
Processing time: 128 Days and 13.3 Hours
Core Tip

Core tip: Cirrhosis mortality varies across hospitals, but it is not well-understood what differences between hospitals contribute to this variation. In our study, using administrative data on cirrhosis discharges and a national dataset on hospital structural characteristics, we found that several hospital factors including payer-mix and staffing patterns were associated with risk-adjusted mortality, but hospital experience with cirrhosis and presence of a liver transplant program were associated with survival. Structural factors are vital components to cirrhosis care delivery, and account for a significant proportion of the variation in cirrhosis mortality observed between hospitals. Future research should focus on other areas of variation, including differences in processes of cirrhosis care.