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

doi:10.4254/wjh.v12.i6.288

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 12, Issue 6

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Supplementary Materials of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (5091)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Tables (1-6) series.

Item

Count

PDF

285

WORD

133

HTML

2608

Tables (1-6)

262

Sum=3288

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

720

Download

1083

Sum=1803

Jun 27, 2020 (publication date) through Oct 2, 2024

Times Cited of This Article

Times Cited (4)

Journal Information of This Article

Publication Name

World Journal of Hepatology

ISSN

1948-5182

Publisher of This Article

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