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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
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.
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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ 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
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.
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.
