TY - JOUR
T1 - A retrospective study on use of palliative care for patients with alcohol related end stage liver disease in United States
AU - Gupta, Kamesh
AU - Hans, Bandhul
AU - Khan, Ahmad
AU - Sohail, Syed Hamza
AU - Kapuria, Devika
AU - Chang, Chris
N1 - Publisher Copyright:
© The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved
PY - 2022/9/27
Y1 - 2022/9/27
N2 - BACKGROUND Palliative care (PC) has been shown to be beneficial in end stage liver disease (ESLD), yet the hospitalization data for PC utilization is unknown. AIM To identify the trend of PC utilization for the special population of alcoholassociated ESLD patients, factors affecting its use and ascertain its impact on healthcare utilization. METHODS We analyzed around 78 million discharges from the 2007-2014 national inpatient sample and 2010-2014 national readmission database including adult patients admitted for decompensated alcohol-associated cirrhosis. We identified patients with PC consultation as a secondary diagnosis. Odds ratios (OR) and means were adjusted for confounders using multivariate regression analysis models. RESULTS Out of the total 1421849 hospitalizations for decompensated liver cirrhosis, 62782 (4.4%) hospitalizations had a PC consult, which increased from 0.8% (1258) of all alcohol-associated ESLD hospitalizations in 2007 to 6.6% in 2014 (P < 0.01). Patient and hospital characteristics associated with increased odds of PC utilization were advanced age, lower income, Medicaid coverage, teaching institution, urban location, length of stay > 3 d, prolonged ventilation, and administration of total parenteral nutrition (all P < 0.01). Palliative encounters in alcohol-associated ESLD and acute-onchronic liver failure (ACLF) score were associated with increased odds of discharge to a rehabilitation facility, but significantly lower odds of 30-d readmissions (aOR: 0.35, 95%CI: 0.31-0.41), lower total hospitalization charges and lower mean hospitalization days (all P < 0.01). CONCLUSION Inpatient PC is sparingly used for patients with decompensated alcohol related liver disease, however it has increased over the past decade.
AB - BACKGROUND Palliative care (PC) has been shown to be beneficial in end stage liver disease (ESLD), yet the hospitalization data for PC utilization is unknown. AIM To identify the trend of PC utilization for the special population of alcoholassociated ESLD patients, factors affecting its use and ascertain its impact on healthcare utilization. METHODS We analyzed around 78 million discharges from the 2007-2014 national inpatient sample and 2010-2014 national readmission database including adult patients admitted for decompensated alcohol-associated cirrhosis. We identified patients with PC consultation as a secondary diagnosis. Odds ratios (OR) and means were adjusted for confounders using multivariate regression analysis models. RESULTS Out of the total 1421849 hospitalizations for decompensated liver cirrhosis, 62782 (4.4%) hospitalizations had a PC consult, which increased from 0.8% (1258) of all alcohol-associated ESLD hospitalizations in 2007 to 6.6% in 2014 (P < 0.01). Patient and hospital characteristics associated with increased odds of PC utilization were advanced age, lower income, Medicaid coverage, teaching institution, urban location, length of stay > 3 d, prolonged ventilation, and administration of total parenteral nutrition (all P < 0.01). Palliative encounters in alcohol-associated ESLD and acute-onchronic liver failure (ACLF) score were associated with increased odds of discharge to a rehabilitation facility, but significantly lower odds of 30-d readmissions (aOR: 0.35, 95%CI: 0.31-0.41), lower total hospitalization charges and lower mean hospitalization days (all P < 0.01). CONCLUSION Inpatient PC is sparingly used for patients with decompensated alcohol related liver disease, however it has increased over the past decade.
KW - Alcohol-associated cirrhosis
KW - End stage liver disease
KW - National inpatient sample
KW - National readmission database
KW - Palliative care
UR - http://www.scopus.com/inward/record.url?scp=85138596169&partnerID=8YFLogxK
U2 - 10.4254/wjh.v14.i9.1817
DO - 10.4254/wjh.v14.i9.1817
M3 - Article
C2 - 36185714
AN - SCOPUS:85138596169
SN - 1948-5182
VL - 14
SP - 1817
EP - 1829
JO - World Journal of Hepatology
JF - World Journal of Hepatology
IS - 9
ER -