Inpatient burden of esophageal varices in the United States: analysis of trends in demographics, cost of care, and outcomes

Abstract

Background: Esophageal variceal bleeding remains a common reason for hospitalization in the United States. The main objective of this study was to analyze demographic variations and outcomes in hospitalizations related to esophageal varices (EV) in the US.Methods: We performed a retrospective observational cohort study using National Inpatient Sample (NIS) database for all hospitalizations with discharge diagnoses of EV, with and without hemorrhage from 2001 to 2011.Results: In 2001, there were 19,167 hospitalizations with discharge diagnoses of EV with and without bleeding compared to 45,578 in 2011 (P<0.001). There was a 138% increase in the number of total EV hospitalizations, a 221% increase in hospitalizations with EV without hemorrhage, and a 7% increase in hospitalizations for patients with EV and hemorrhage. Age group 50-64 was the most affected, accounting for 31.4% of EV hospitalizations in 2001 and 46.7% of EV hospitalizations in 2011 (P<0.001). The overall in-hospital mortality rate was 3.4% for patients with EV without hemorrhage and 8.7% for patients with EV with hemorrhage (P=0.0003). Conclusions:The number of hospitalizations for patients with asymptomatic EV increased significantly between 2001 to 2011, with only a small concurrent increase in the number of hospitalizations for patients with esophageal variceal bleeding.

Trends of Readmissions for Gastrointestinal Bleeding After Alcoholic Hepatitis: Analysis of the Nationwide Readmission Database

“…Consistent with the available data from AH and cirrhosis patients [ 18 , 19 ], we observed an increase in the proportion of patients readmitted for EVB over the studied period. Recently, the severity, comorbidities, and complications associated with AH have worsened [ 6 ].…”

Missed diagnosis of cirrhosis in the inpatient setting

“…Looking specifically at EV, there has been an increase in hospitalizations for EV with and without bleeding. From 2001 to 2011, hospitalizations with a discharge diagnosis of EV with and without bleeding increased from 19,167 to 45,578 38 . There was a 221% increase in hospitalization with EV without hemorrhage and a 7% increase in hospitalizations with hemorrhage.…”

“…When the SAAG is ≥1.1 and total protein is high (≥2.5), the etiology is usually cardiac. 37 Early 38 With increasing number of EV, there will be an increase in the number of diagnostic and theraputic endoscopies for varices management. The average hospital cost for variceal bleed was $6612, and if there were complications or rebleeding, the cost increased to $23,207.…”

Gastric Antral Vascular Ectasia: Trends of Hospitalizations, Biodemographic Characteristics, and Outcomes With Watermelon Stomach

“…We used the Cochran-Armitage trend test to calculate the trends for categorical variables and Wilcoxon rank sum test to assess continuous variables. These methods have been used in previous NIS-based studies [ 8 , 10 , 11 ]. We used the multivariate logistic regression model to determine predictors of mortality.…”