A retrospective study on use of palliative care for patients with alcohol related end stage liver disease in United States

doi:10.4254/wjh.v14.i9.1817

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World Journal of Hepatology

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Observational Study

World J Hepatol. Sep 27, 2022; 14(9): 1817-1829
Published online Sep 27, 2022. doi: 10.4254/wjh.v14.i9.1817

A retrospective study on use of palliative care for patients with alcohol related end stage liver disease in United States

Kamesh Gupta, Bandhul Hans, Ahmad Khan, Syed Hamza Sohail, Devika Kapuria, Chris Chang

Kamesh Gupta, Department of Gastroenterology, UMass Chan Medical School-Baystate, Springfield, MA 01199, United States

Bandhul Hans, Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, United States

Ahmad Khan, Department of Gastroenterology, Case Western University, Cleveland, OH 44106, United States

Syed Hamza Sohail, Department of Internal Medicine, UMass Chan Medical School-Baystate, Springfield, MA 01199, United States

Devika Kapuria, Department of Gastroenterology, Washington University, St. Louis, MO 63110, United States

Chris Chang, Department of Gastroenterology, University of New Mexico, Alberquerque, NM 46111, United States

Author contributions: Hans B and Gupta K contributed equally to this manuscript and should be considered co-first authors; Chang C and Kapuria D have equal contribution and are joint senior authors; Hans B and Gupta K devised the statistical analysis plan, wrote the statistical code and contributed in writing the manuscript; Kapuria D conceived the study idea and contributed in writing the manuscript; Khan A ran the statistical tests; Sohail SH performed a background literature search; Chang C was our faculty mentor who revised and edited the final manuscript; all authors provided critical feedback and helped shape the research analysis and manuscript.

Institutional review board statement: Since the paper contains data from a nationalized, publicly available, de-identified database, the paper is exempted for institutional review board.

Informed consent statement: Since the paper contains data from a nationalized, publicly available, de-identified database, the paper is exempted for institutional review board. Further, no patient consent was required for the same as no intervention was performed during the study.

Conflict-of-interest statement: There are no conflicts of interest to report.

Data sharing statement: The database utlized is available with permission at https://www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Corresponding author: Kamesh Gupta, MD, Doctor, Department of Gastroenterology, UMass Chan Medical School-Baystate, 759 Chestnut St, Springfield, MA 01199, United States. kamesh.guptamd@bhs.org

Received: May 18, 2022
Peer-review started: May 18, 2022
First decision: June 23, 2022
Revised: July 4, 2022
Accepted: September 9, 2022
Article in press: September 9, 2022
Published online: September 27, 2022
Processing time: 119 Days and 9.8 Hours

Abstract

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 alcohol-associated 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-on-chronic 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. PC consultation is associated with lower 30-d readmission rates on multivariate analysis, and lower hospitalization cost and length of stay in patients with ACLF score ≥ 2.

Keywords: Alcohol-associated cirrhosis; Palliative care; End stage liver disease; National inpatient sample; National readmission database

Core Tip: Alcohol related end stage liver disease (ESLD) carries a poor prognosis and is associated with significant loss of quality of life and symptom burden. We found that inpatient palliative care is sparingly used for patients with decompensated alcohol related liver disease, however it has increased over the past decade. Palliative care referral is associated with decreased hospitalization cost and length of stay in acute-on-chronic liver failure Positive alcohol-associated ESLD patients, as well as decreased rehospitalization rates in all alcohol associated ESLD patients.