Trends in Hospitalizations of Esophageal Varices From 2011 to 2018: A United States Nationwide Study.

IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Gastroenterology Research Pub Date : 2023-06-01 DOI:10.14740/gr1627
Abdelwahap Elghezewi, Mohamad Hammad, Mohammed El-Dallal, Mujtaba Mohamed, Ahmed Sherif, Wesam Frandah
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Abstract

Background: Prevalence of gastroesophageal varices is around 50% of patients with cirrhosis. In compensated cirrhosis they are present in 30-40%. Progression from small to large varices occurs at rate of 10-12% annually. That percentage increases significantly in decompensated liver cirrhosis with gastroesophageal varices found in 85% of patients. Variceal hemorrhage occurs at a rate around 10-15% per year. The outcome of variceal hemorrhage depends on the severity of liver disease, size of varices, and presence of stigmata of recent bleeding (red whale sign). Six-week mortality of variceal hemorrhage ranges between 15% and 25%. Without treatment, variceal hemorrhage tends to recur in 60% of patients within 1 - 2 years. The aim of the study was to assess demographics of esophageal varices with and without bleeding, geographic distribution, comorbidities, outcomes, main payers, and cost of hospitalizations.

Methods: The National Inpatient Sample (NIS) database from year 2011 to 2018 was used. Patients who had a primary diagnosis of esophageal varices with or without bleeding were identified using the International Classification of Diseases, Ninth Revision (ICD-9) codes (456.0 for esophageal varices with bleeding, and 456.1 for esophageal varices without bleeding), and International Classification of Diseases, 10th Revision (ICD-10) codes (I85.01 for esophageal varices with bleeding, and I85.00 for esophageal varices without bleeding) in the first two discharge diagnoses. The propensity score to calculate the inverse probability treatment weighting (IPTW) to adjust between the differences of the compared groups was implemented. Two groups were compared in terms of their hospitalization outcomes, including LOS, hospital charges, hospital mortality, and disposition.

Results: A total of 322,761 patients were admitted with esophageal varices between 2011 and 2018, with 236,802 (73.6%) had bleeding esophageal varices and 85,959 (26.4%) had nonbleeding esophageal varices. The majority of the patients from both groups were white (66%), covered with Medicare (38% in the esophageal varices with bleeding vs. 41% in the nonbleeding group). There was a steady increase of patients admitted with nonbleeding esophageal varices. Most common comorbidities were liver diseases, alcohol abuse, uncomplicated hypertension and depression in both groups. There were no significant changes in OLS over the years in both groups, but there was a significant increase in hospital charges, especially in the patients with bleeding esophageal varices starting in 2015, and no change in mortality throughout the years. Regarding hospital disposition, there was a notable decline in rehab discharge in the bleeding esophageal varices group.

Conclusions: Esophageal varices with and without bleeding have been steadily increasing since the beginning of this century. This may result in a substantial impact on increasing health care costs and utilization due to acute variceal hemorrhage. Odds of death, transfer to urban hospital, and transfer to visiting nursing assistance remained unchanged.

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2011年至2018年食道静脉曲张住院趋势:一项美国全国性研究
背景:胃食管静脉曲张在肝硬化患者中的患病率约为50%。代偿性肝硬化中有30-40%存在。从小静脉曲张到大静脉曲张的进展速度为每年10-12%。在85%的失代偿性肝硬化伴胃食管静脉曲张患者中,这一比例显著增加。静脉曲张出血的发生率约为每年10-15%。静脉曲张出血的结果取决于肝脏疾病的严重程度、静脉曲张的大小和近期出血的红斑(红鲸征)。静脉曲张出血的6周死亡率在15%到25%之间。如果不进行治疗,60%的患者会在1 - 2年内静脉曲张出血复发。本研究的目的是评估伴有和不伴有出血的食管静脉曲张的人口统计学特征、地理分布、合并症、结局、主要支付者和住院费用。方法:使用2011 - 2018年国家住院患者样本(NIS)数据库。初步诊断为食管静脉曲张伴出血或不伴出血的患者,在前两项出院诊断中采用国际疾病分类第九版(ICD-9)代码(有出血的食管静脉曲张456.0,无出血的食管静脉曲张456.1)和国际疾病分类第十版(ICD-10)代码(有出血的食管静脉曲张I85.01,无出血的食管静脉曲张I85.00)进行鉴定。采用倾向评分法计算逆概率处理权重(IPTW),以调整比较组间的差异。比较两组患者的住院结果,包括LOS、住院费用、住院死亡率和处置情况。结果:2011年至2018年期间,共有322,761例食管静脉曲张患者入院,其中236,802例(73.6%)为食管静脉曲张出血,85,959例(26.4%)为非出血性食管静脉曲张。两组的大多数患者都是白人(66%),有医疗保险(食管静脉曲张出血组38%,非出血组41%)。非出血性食管静脉曲张入院的患者稳步增加。两组中最常见的合并症是肝脏疾病、酗酒、无并发症的高血压和抑郁症。两组的OLS历年无明显变化,但住院费用显著增加,尤其是2015年开始出现食管静脉曲张出血的患者,死亡率历年无变化。在住院处理方面,出血性食管静脉曲张组的康复出院率明显下降。结论:自本世纪初以来,伴出血和不伴出血的食管静脉曲张一直在稳步增加。由于急性静脉曲张出血,这可能会对增加医疗保健费用和利用率产生重大影响。死亡、转到城市医院和转到探访护理协助的几率保持不变。
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Gastroenterology Research
Gastroenterology Research GASTROENTEROLOGY & HEPATOLOGY-
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