Published online Jan 27, 2019. doi: 10.4254/wjh.v11.i1.74
Peer-review started: October 15, 2018
First decision: November 1, 2018
Revised: December 29, 2015
Accepted: January 9, 2019
Article in press: January 9, 2019
Published online: January 27, 2019
Processing time: 107 Days and 21.9 Hours
There is limited data on recent temporal trends of cirrhosis associated conditions in the United States, which is critical to identify problems related to hospitalizations.
Healthcare cost reduction, especially in the United States, is a current focus on providing cost-effective care. Recognizing problems in temporal trends enables to create action plan to reduce unnecessary costs.
We aim to conduct a descriptive study to identify 10-year temporal trends of cirrhosis associated conditions which can guide future prospective studies.
We used publicly available National Inpatient Sample to conduct 10-year trends analysis of cirrhosis associated conditions identified by ICD-9 codes from 2005 to 2014. Simple linear regression and multiple regression models were utilized for statistical analysis.
The total number of discharges of Hepatic encephalopathy/coma (HC), Spontaneous bacteria peritonitis (SBP) and esophageal varices with bleeding (EV) had significant increase. Notably, HC associated with viral hepatitis showed faster rate of increase of hospitalizations. Mortalities has decreased for HC, SBP and transjugular intrahepatic portosystemic shunt (TIPS), but no change was observed for EV. Aggregate cost of hospitalizations for HC, EV and SBP had significant increase after adjustment for inflation; however TIPS showed non-significant trends toward decreasing cost.
The number of hospitalizations and costs for some of the cirrhosis-associated conditions increased. Especially, HC related to viral hepatitis showed fast rate of increase which suggest appropriate treatment of viral hepatitis maybe necessary to reduce HC in these population. In addition, the inpatient mortality rates for most of these conditions decreased.
Viral hepatitis related cirrhosis maybe contributing to high cost of hospitalization especially hospitalization related to HC. These findings suggest necessity of studies beyond 2014 after introduction of newer antiviral agents for hepatitis C as well as studies to identify trends of re-admission and post-hospitalization mortality.