Disparities in Mortality and Health Care Utilization for 460,851 Hospitalized Patients with Cirrhosis and Hepatic Encephalopathy

Overt Hepatic Encephalopathy: Current Pharmacologic Treatments and Improving Clinical Outcomes

“…In contrast to data showing both increased admissions and readmissions for hepatic encephalopathy, [18][19][20][21]23 data from the NIS showed that in-hospital hepatic encephalopathy-related mortality, though substantial, has decreased significantly from 2009 to 2013 (11.9%-10.2%, respectively; P < .001). 14 The mean length of hospitalization was also significantly reduced, from 7.5 days (2009) to 7.1 days (2013; P = .02). 14 An increased risk of mortality in patients with hepatic encephalopathy is associated with increasing age (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.01-1.02), lack of health insurance (OR, 1.7; 95% CI, 1.4-2.0), 16 and an increasing number of comorbidities (OR, 1.08; 95% CI, 1.05-1.11).…”

“…The number of hepatic encephalopathy-related hospitalizations has been increasing, with a substantial increase observed between 2009 and 2013 (from 75,475 to 106,915; International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 572.2). 14 Furthermore, the prevalence of hepatic encephalopathy-related hospitalizations increased from 191 per 100,000 hospitalizations in 2009 to 300 per 100,000 in 2013. 14 During a 4-year time frame (2010-2014), using a US national inpatient sample, hepatic encephalopathy hospitalizations increased significantly by 24.4% (25,059 to 31,182; P < .001).…”

“…14 Furthermore, the prevalence of hepatic encephalopathy-related hospitalizations increased from 191 per 100,000 hospitalizations in 2009 to 300 per 100,000 in 2013. 14 During a 4-year time frame (2010-2014), using a US national inpatient sample, hepatic encephalopathy hospitalizations increased significantly by 24.4% (25,059 to 31,182; P < .001). 15 According to HCUP, 52,133 hepatic encephalopathy-related emergency department visits occurred in 2016; of these, 39,121 resulted in admission to the same hospital.…”

Hepatic Encephalopathy-Related Hospitalizations in Cirrhosis: Transition of Care and Closing the Revolving Door

“…Repeat hospitalizations can place substantial financial burden on healthcare systems. For example, larger hospitals and teaching and safety-net hospitals treating Medicare patients in the HRRP, which were more likely to treat a sicker and more socioeconomically disadvantaged population, had higher readmission rates than smaller hospitals and non-teaching and nonsafety-net hospitals and were [20]. However, there was a significant decrease in the mean length of hospitalization (7.6 days vs. 7.1 days, respectively) and inpatient mortality (11.9% vs. 10.2%) during this time [20].…”

“…For example, larger hospitals and teaching and safety-net hospitals treating Medicare patients in the HRRP, which were more likely to treat a sicker and more socioeconomically disadvantaged population, had higher readmission rates than smaller hospitals and non-teaching and nonsafety-net hospitals and were [20]. However, there was a significant decrease in the mean length of hospitalization (7.6 days vs. 7.1 days, respectively) and inpatient mortality (11.9% vs. 10.2%) during this time [20]. The burden of hospitalizations on caregivers cannot be overlooked, as a study showed that caregivers of patients with more than 2 hospitalizations due to complications of liver disease within a year were more likely to experience caregiver burden (Zarit Burden Interview score > 21) than other caregivers [21].…”