Hospital teaching status on the outcomes of patients with esophageal variceal bleeding in the United States

doi:10.4254/wjh.v12.i6.288

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Hepatol. Jun 27, 2020; 12(6): 288-297
Published online Jun 27, 2020. doi: 10.4254/wjh.v12.i6.288

Table 1 Patient demographics and hospital characteristics

Variable	All (58362)	Teaching (30382)	Non-teaching (27979)	P value
Patient age (yr)				< 0.001
Median (SD)	55 (12.05)	54 (11.83)	55 (12.21)
Sex				0.650
Female	18550 (31.8)	9601 (31.6)	8953 (32.0)
Male	39803 (68.2)	20781 (68.4)	19026 (68.0)
Race				< 0.001
White	35192 (60.3)	17166 (56.5)	18018 (64.4)
Black	4202 (7.2)	2917 (9.6)	1287 (4.6)
Hispanic	11030 (18.9)	5924 (19.5)	5092 (18.2)
Asian or Pacific Islander	1167 (2.0)	668 (2.2)	532 (1.90)
Native American	875 (1.5)	486 (1.6)	392 (1.40)
Other	1751 (3.0)	1063 (3.5)	699 (2.50)
Missing	4144 (7.1)	2188 (7.2)	1959 (7.0)
Primary payer				< 0.001
Medicare	18442 (31.6)	8720 (28.7)	9709 (34.7)
Medicaid	13540 (23.2)	7869 (25.9)	5680 (20.3)
Private and HMO	14824 (25.4)	7960 (26.2)	6855 (24.5)
Self-pay	7587 (13.0)	3767 (12.4)	3805 (13.6)
No charge	700 (1.2)	425 (1.4)	308 (1.1)
Other	3268 (5.6)	1671 (5.5)	1539 (5.5)
Hospital bed size				< 0.001
Small	6245 (10.7)	4102 (13.5)	2182 (7.8)
Medium	15408 (26.4)	8051 (26.5)	7386 (26.4)
Large	36710 (62.9)	18229 (60.0)	18410 (65.8)
Hospital region				< 0.001
Northeast	10564 (18.1)	6988 (23.0)	3581 (12.8)
Midwest	9571 (16.4)	5621 (18.5)	3917 (14.0)
South	23170 (39.7)	11636 (38.3)	11555 (41.3)
West	15057 (25.8)	6137 (20.2)	8925 (31.9)
Transfer in from acute care hospital				< 0.001
Yes	4319 (7.4)	3494 (11.5)	839 (3.0)
No	54043 (92.6)	26888 (88.5)	27140 (97.0)

Table 2 Patient comorbidities and management

Variable	All (58362)	Teaching (30382)	Non-teaching (27979)
Variable	All (58362)	Teaching (30382)	Non-teaching (27979)
Elixhauser comorbidities^a
0	2568 (4.4)	1398 (4.6)	1175 (4.2)
1	8929 (15.3)	4679 (15.4)	4281 (15.3)
2	14707 (25.2)	7565 (24.9)	7135 (25.5)
≥ 3	32157 (55.1)	16740 (55.1)	15388 (55.0)
Liver comorbidities
Alcoholic cirrhosis	30232 (51.8)	16102 (53.0)	14157 (50.6)
Ascites	19551 (33.5)	10998 (36.2)	8534 (30.5)
Hepatic encephalopathy	9280 (15.9)	5286 (17.4)	4001 (14.3)
SBP	1109 (1.9)	760 (2.5)	336 (1.2)
Hepatorenal syndrome	1868 (3.2)	1276 (4.2)	616 (2.2)
Coagulopathy^a	27255 (46.7)	14340 (47.2)	12870 (46.0)
Hepatocellular carcinoma	2101 (3.6)	1398 (4.6)	699 (2.5)
Management
Blood transfusion	36184 (62.0)	18199 (59.9)	17963 (64.2)
Balloon tamponade	525 (0.9)	365 (1.2)	168 (0.6)
Portosystemic shunt	3268 (5.6)	2400 (7.9)	867 (3.1)

^aP > 0.05 in comparison between groups. All data are proportions [n (%)]. Comparisons between groups made with χ² test. All comparisons had P < 0.001 between groups unless otherwise stated.

Table 3 Mortality associated with patient demographics and hospital characteristics

Variable	Mortality (%)^a	Unadjusted OR (95%CI)	Adjusted OR (95%CI)¹	P value
Variable	Mortality (%)^a	Unadjusted OR (95%CI)	Adjusted OR (95%CI)¹	P value
Patient age (yr)				0.226
Age < 40	5.5%	1.0	1.0
Age 40-59	6.7%	1.226 (0.900-1.669)	1.182 (0.858-1.628)	0.196
Age > 60	7.1%	1.312 (0.955-1.801)	1.397 (0.989-1.974)	0.094
Sex				0.001
Female	5.6%	1.0	1.0
Male	7.3%	1.323 (1.126-1.555)	1.271 (1.075-1.503)	0.005
Race				0.001
White	6.4%	1.0	1.0
Black	10.2%	1.664 (1.308-2.118)	1.607 (1.246-2.074)	< 0.001
Hispanic	6.1%	0.948 (0.778-1.155)	0.942 (0.766-1.157)	0.567
Asian or Pacific Islander	6.6%	1.040 (0.621-1.742)	1.046 (0.619-1.768)	0.867
Native American	6.7%	1.062 (0.587-1.922)	1.071 (0.572-2.002)	0.831
Other	7.6%	1.214 (0.971-1.518)	1.131 (0.895-1.429)	0.304
Primary payer				0.001
Medicare	6.7%	1.0	1.0
Medicaid	7.9%	1.180 (0.978-1.423)	1.027 (0.844-1.250)	0.789
Private and HMO	6.0%	0.887 (0.729-1.078)	0.837 (0.683-1.026)	0.087
Self-pay	7.2%	1.069 (0.849-1.346)	1.098 (0.864-1.395)	0.445
No charge	4.0%	0.580 (0.254-1.326)	0.517 (0.214-1.247)	0.142
Other	4.9%	0.706 (0.487-1.025)	0.671 (0.456-0.988)	0.043
Hospital bed size				0.001
Small	5.2%	1.0	1.0
Medium	5.8%	1.115 (0.836-1.486)	1.094 (0.814-1.470)	0.551
Large	7.4%	1.458 (1.123-1.892)	1.272 (0.970-1.668)	0.082
Hospital region				0.143
Northeast	7.4%	1.0	1.0
Midwest	7.1%	0.961 (0.760-1.216)	0.960 (0.744-1.238)	0.752
South	6.1%	0.814 (0.667-0.994)	0.914 (0.740-1.129)	0.403
West	7.0%	0.946 (0.766-1.169)	1.110 (0.882-1.397)	0.372
Transfer in from acute care hospital				< 0.001
No	6.2%	1.0	1.0
Yes	11.9%	2.041 (1.643-2.536)	1.490 (1.172-1.894)	0.001
Hospital teaching status				< 0.001
Teaching	8.0%	1.557 (1.345-1.803)	1.249 (1.066-1.463)	0.006
Non-teaching	5.3%	1.0	1.0

^aP < 0.001 for all comparisons of crude mortality between groups in bivariate χ² analyses.

¹Adjusted for age, sex, race, primary insurance, hospital bed size, region, transfer status, features of hepatic decompensation, and management.

Table 4 Patient comorbidities and management with associated mortality

Variable	Mortality overall (n = 58362)	Mortality teaching (n = 30382)	Mortality non-teaching (n = 27979)
Variable	Mortality overall (n = 58362)	Mortality teaching (n = 30382)	Mortality non-teaching (n = 27979)
Elixhauser comorbidities
0	4202 (7.2)	3008 (9.9)	1455 (5.2)
1	4085 (7.0)	2734 (9.0)	1287 (4.6)
2	4144 (7.1)	2886 (9.5)	1371 (4.9)
≥ 3	3794 (6.5)	2157 (7.1)	1567 (5.6)
Liver comorbidities
Alcoholic cirrhosis^a	4494 (7.7)	2795 (9.2)	1763 (6.3)
Ascites	5953 (10.2)	3585 (11.8)	2266 (8.1)
Hepatic encephalopathy	9338 (16.0)	5165 (17.0)	3973 (14.2)
SBP	11322 (19.4)	8294 (27.3)	1567 (5.6)
Hepatorenal syndrome	23695 (40.6)	12335 (40.6)	11415 (40.8)
Coagulopathy	4844 (8.3)	2917 (9.6)	1931 (6.9)
Hepatocellular carcinoma	7821 (13.4)	4770 (15.7)	2266 (8.1)
Management
Blood transfusion	4319 (7.4)	2643 (8.7)	1735 (6.2)
Balloon tamponade	30290 (51.9)	15616 (51.4)	14857 (53.1)
Portosystemic shunt	8871 (15.2)	5195 (17.1)	2770 (9.9)

^aP > 0.05 in comparison between groups. All data are proportions [n (%)]. Comparisons between groups made with χ² test. All comparisons had P < 0.001 between groups unless otherwise stated.

Table 5 Length of stay and cost of hospitalization

Variable	All (58362)	Teaching (30382)	Non-teaching (27979)	P value
Variable	All (58362)	Teaching (30382)	Non-teaching (27979)	P value
Length of stay				< 0.001
Median (IQR) in days	4 (3-7)	5 (3-8)	4 (3-6)
Cost of hospitalization				< 0.001
Mean in US dollars (SD)	$19049 (11880)	$22355 (12996)	$15535 (10935)

IQR: Interquartile range.

Table 6 Mortality, length of stay and cost in teaching vs nonteaching logistic regression

Variable	OR/coefficient	95%CI	P value
Mortality	1.249	1.066-1.463	0.006
LOS	1.72	1.46-1.97	< 0.001
Cost	6651	5646-7656	< 0.001

LOS: Length of stay; OR: Odds ratio.

Citation: Patel P, Rotundo L, Orosz E, Afridi F, Pyrsopoulos N. Hospital teaching status on the outcomes of patients with esophageal variceal bleeding in the United States. World J Hepatol 2020; 12(6): 288-297
URL: https://www.wjgnet.com/1948-5182/full/v12/i6/288.htm
DOI: https://dx.doi.org/10.4254/wjh.v12.i6.288