Physician Specialty and the Outcomes and Cost of Admissions for End-Stage Liver Disease

Ko, Cynthia W.; Kelley, Keith; Meyer, Kerry E.
December 2001
American Journal of Gastroenterology;Dec2001, Vol. 96 Issue 12, p3411
Academic Journal
OBJECTIVES: Chronic liver disease is a frequent cause of morbidity and mortality. The aim of this study was to characterize the effects of physician specialty on length of stay, mortality, and costs during hospitalizations for end-stage liver disease. METHODS: We used data from the HBS International EXPLORE database. Patients hospitalized for treatment of variceal hemorrhage, spontaneous bacterial peritonitis, or hepatic encephalopathy were identified from primary discharge diagnoses. Patients were characterized by the specialty of the attending physician and by whether a gastroenterology consultation was obtained. Procedures performed were identified using ICD-9CM procedure codes. Costs were computed using proprietary HBS International Standard Transaction Codes. Linear and logistic regression analyses were used to examine the effect of physician specialty and consultation on length of stay, in-hospital mortality, and costs. RESULTS: Attending gastroenterologist care was associated with a shorter length of stay compared to nongastroenterologist attending care (median 4 vs 5 days, p = 0.01), which persisted after adjustment for differences in patient age, comorbidity, and number of procedures performed. There was a strong trend toward greater in-hospital mortality for patients without a gastroenterology attending or consultant (adjusted OR 1.72; 95% CI = 0.99, 2.98) compared to patients with a gastroenterology attending. Costs of hospital care were not significantly different between physician groups. CONCLUSIONS: Gastroenterologist involvement in inpatient care for end-stage liver disease was associated with shorter length of stay and a strong trend toward improved survival. Hospital costs were similar for patients cared for by the different physician groups.


Related Articles

  • TIPSS FOR REFRACTORY ASCITES: ARE THE TRIALS WRONG?  // Gut;Apr2004 Supplement 3, Vol. 53, pA90 

    The article presents a study of transjugular intrahepatic portosystemic shunting (TIPSS) for refractory ascites. TIPSS has been compared to large volume paracenthesis in four randomised controlled trials with mostly poor results. It can be an effective procedure for highly selected patients with...

  • Prognostic Indicators of Survival in Patients with Cirrhosis and Esophageal Varices, without Previous Bleeding. Merkel, Carlo; Bolognesi, Massimo; Angeli, Paolo; Noventa, Franco; Caregaro, Lorenza; Sacerdoti, David; Gatta, Angelo // American Journal of Gastroenterology;Jul1989, Vol. 84 Issue 7, p717 

    Sixty-one patients with cirrhosis with varices without previous bleeding were admitted to our Department over a period of 2 yr. Fifty had alcoholic cirrhosis. Child-Turcotte- Pugh class was A in 11 patients, B in 30, and C in 20. Varices were F1 in 18, and F2-F3 in 43. During follow-up of up to...


    The article presents a study of the use of transjugular intrahepatic protosystemic shunt (TIPSS) in the treatment of ectopic variceal bleeding. Bleeding from ectopic (rectal and stomal) varices is a well recognised complication of portal hypertension. There are few data in the literature on...

  • Varicose bleeding after liver transplantation in a patient with severe portosystemic shunts. Nosaka, Toshihisa; Teramoto, Kenichi; Tanaka, Yujiro; Igari, Toru; Takamatsu, Susumu; Kawamura, Toru; Inoue, Yoshinori; Goseki, Narihide; Arii, Shigeki; Iwai, Takehisa; Inomata, Yukihiro; Tanaka, Koichi // Journal of Gastroenterology;2003, Vol. 38 Issue 7, p700 

    Discusses the case of a 30-year-old male patient who suffered recurrent varicose bleeding after some portosystemic shunts were ligated during orthotopic liver transplantation. Medical history; Physical condition; Portal vein blood flow rate; Clinical condition after the operation.

  • Primary Prophylaxis Against Variceal Bleeding:β-Blockers, Endoscopic Ligation, or Both? Chalasani, Naga; Boyer, Thomas D. // American Journal of Gastroenterology;Apr2005, Vol. 100 Issue 4, p805 

    Variceal bleeding is one of the complications of cirrhosis that leads to significant morbidity and mortality. It is recommended that all patients with cirrhosis be screened for gastroesophageal varices and those with large varices should be offered primary prophylaxis. Nonselective beta-blockers...

  • Successful Endoscopic Injection Sclerotherapy of a Bleeding Duodenal Varix. Barbish, Allan Walter; Ehrinpreis, Murray N. // American Journal of Gastroenterology;Jan1993, Vol. 88 Issue 1, p90 

    Bleeding from duodenal varices is an unusual event. We report the case of a 50-yr-old man with portal hypertension due to alcoholic cirrhosis who presented with upper gastrointestinal bleeding and encephalopathy. Emergent endoscopy revealed an actively bleeding duodenal varix. The bleeding was...

  • Cost-Effective Analysis of Transjugular Intrahepatic Portosystemic Shunt versus Surgical Portacaval Shunt for Variceal Bleeding in Early Cirrhosis. PIERCE, DAMON S.; SPERRY, JASON; NIRULA, RAMINDER // American Surgeon;Feb2011, Vol. 77 Issue 2, p169 

    Upper gastrointestinal hemorrhage carries significant morbidity and mortality in patients with portal hypertension and cirrhosis. The optimal prevention strategy for rebleeding in these patients remains controversial with respect to the safety and efficacy of transjugular intrahepatic...

  • How Much Reduction in Portal Pressure Is Necessary to Prevent Variceal Rebleeding? A Longitudinal Study in 225 Patients With Transjugular Intrahepatic Portosystemic Shunts. Rössle, Martin; Siegerstetter, Volker; Olschewski, Manfred; Ochs, Andreas; Berger, Elisabeth; Haag, Klaus // American Journal of Gastroenterology;Dec2001, Vol. 96 Issue 12, p3379 

    OBJECTIVES: This longitudinal study determines the risk of rebleeding in relation to the reduction of the portosystemic pressure gradient in patients with a transjugular intrahepatic portosystemic shunt (TIPS) for variceal bleeding. METHODS: The study included 225 patients in whom a TIPS...

  • Preventing Initial Bleeding in Cirrhosis-Induced Varices. Sadovsky, Richard // American Family Physician;2/1/2003, Vol. 67 Issue 3, p609 

    Discusses the study 'Primary Prophylaxis of Variceal Hemorrhage: A Randomized Controlled Trial Comparing Band Ligation, Propranol, and Isosorbide Mononitrate,' by H.F. Lui et al., from the September 2002 issue of 'Gastroenterology.'


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics