Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 27, 2020; 12(6): 288-297
Published online Jun 27, 2020. doi: 10.4254/wjh.v12.i6.288
Hospital teaching status on the outcomes of patients with esophageal variceal bleeding in the United States
Pavan Patel, Laura Rotundo, Evan Orosz, Faiz Afridi, Nikolaos Pyrsopoulos
Pavan Patel, Faiz Afridi, Nikolaos Pyrsopoulos, Division of Gastroenterology and Hepatology, Rutgers - New Jersey Medical School, Newark, NJ 07101-1709, United States
Laura Rotundo, Evan Orosz, Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ 07101-1709, United States
Author contributions: Patel P provided conception and design of the study, acquisition and analysis of data, and drafting of the manuscript; Rotundo L, Afridi F and Orosz E drafted the manuscript; Pyrsopoulos N contributed to the manuscript by providing revision and oversight of its writing.
Institutional review board statement: This study did not require IRB approval due since the database is representative of nationally acquired data.
Informed consent statement: Due to the retrospective nature of this study as well as the using of a national database no human information was made available to authors. Therefore, informed consent was not needed to write this manuscript.
Conflict-of-interest statement: Authors declare no conflict of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Nikolaos Pyrsopoulos, FACP, MD, PhD, Chief Doctor, Professor, Division of Gastroenterology and Hepatology, Rutgers – New Jersey Medical School, 185 S. Orange Avenue, MSB H-535, Newark, NJ 07101-1709, United States. pyrsopni@njms.rutgers.edu
Received: January 6, 2020
Peer-review started: January 6, 2020
First decision: March 15, 2020
Revised: April 10, 2020
Accepted: May 14, 2020
Article in press: May 14, 2020
Published online: June 27, 2020
Processing time: 173 Days and 10.3 Hours
Abstract
BACKGROUND

Acute variceal bleeding is a major complication of portal hypertension and is a leading cause of death in patients with cirrhosis. There is limited data on the outcomes of patients with esophageal variceal bleeding in teaching versus nonteaching hospitals. Because esophageal variceal bleeding requires complex management, it may be hypothesized that teaching hospitals have lower mortality.

AIM

To assess the differences in mortality, hospital length of stay (LOS) and cost of admission for patients admitted for variceal bleed in teaching versus nonteaching hospitals across the US.

METHODS

The National Inpatient Sample is the largest all-payer inpatient database consisting of approximately 20% of all inpatient admissions to nonfederal hospitals in the United States. We collected data from the years 2008 to 2014. Cases of variceal bleeding were identified using the International Classification of Diseases, Ninth Edition, Clinical Modification codes. Differences in mortality, LOS and cost were evaluated for patients with esophageal variceal bleed between teaching and nonteaching hospitals and adjusted for patient characteristics and comorbidities.

RESULTS

Between 2008 and 2014, there were 58362 cases of esophageal variceal bleeding identified. Compared with teaching hospitals, mortality was lower in non-teaching hospitals (8.0% vs 5.3%, P < 0.001). Median LOS was shorter in nonteaching hospitals as compared to teaching hospitals (4 d vs 5 d, P < 0.001). A higher proportion of non-white patients were managed in teaching hospitals. As far as procedures in nonteaching vs teaching hospitals, portosystemic shunt insertion (3.1% vs 6.9%, P < 0.001) and balloon tamponade (0.6% vs 1.2%) were done more often in teaching hospitals while blood transfusions (64.2% vs 59.9%, P = 0.001) were given more in nonteaching hospitals. Using binary logistic regression models and adjusting for baseline patient demographics and comorbid conditions the mortality, LOS and cost in teaching hospitals remained higher.

CONCLUSION

In patients admitted for esophageal variceal bleeding, mortality, length of stay and cost were higher in teaching hospitals versus nonteaching hospitals when controlling for other confounding factors.

Keywords: Variceal bleeding; Teaching hospital; Mortality; National Inpatient Sample; Length of stay; Bleeding; Cirrhosis

Core tip: This study assesses the outcomes of patients that present to the hospital with variceal bleeding amongst teaching and non-teaching hospitals. Patients that were managed at teaching facilities had higher mortality, length of stay and cost of hospitalization when compared to those at non-teaching facilities.