Inpatient Gastroenterology Consultation and Outcomes of Cirrhosis-Related Hospitalizations in Two Large National Cohorts

Serper, Marina; Kaplan, David E.; Lin, Menghan; Taddei, Tamar H.; Parikh, Neehar D.; Werner, Rachel M.; Tapper, Elliot B.

doi:10.1007/s10620-021-07150-8

Cited by 9 publications

(10 citation statements)

References 42 publications

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“…Furthermore, we observed that GI consultation was associated with higher rates of paracentesis during both eras. This finding is consistent with prior studies showing that the involvement of GI specialists may result in increased adherence to quality indicators for patients admitted with cirrhosis 16 . Rates of timely paracentesis, however, did not increase with GI consultation in our study; although, this may have been related to the timing of consultation, i.e.…”

Section: Discussionsupporting

confidence: 92%

“…This finding is consistent with prior studies showing that the involvement of GI specialists may result in increased adherence to quality indicators for patients admitted with cirrhosis. 16 Rates of timely paracentesis, however, did not increase with GI consultation in our study; although, this may have been related to the timing of consultation, i.e. consultation for certain patients >24 h after admission.…”

Section: Discussioncontrasting

confidence: 66%

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Rates of timely paracentesis for patients admitted to hospital with cirrhosis and ascites remain low but are unaffected by the COVID‐19 pandemic

Aby

Lall

Vasdev

et al. 2022

Journal of Hospital Medicine

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For the first 6 months of the novel coronavirus-19 (COVID-19) pandemic, the hospital medicine procedure service at our center was temporarily unavailable.We assessed paracentesis rates and clinical outcomes for patients admitted with cirrhosis and ascites before and during the COVID-19 pandemic. Two hundred and twenty-four and 131 patients with cirrhosis and ascited were admitted to hospital before and during COVID-19 respectively. Approximately 50.9% and 49.6% of patients underwent a paracentesis within 24 h pre-and mid-pandemic, p = .83. No differences were observed for length-of-stay or 30-day readmissions. GI consultation was associated with higher rates of paracentesis in both eras (p < .001 pre-COVID-19, and p = .01 COVID-19).Changes due to the COVID-19 pandemic did not result in changes to rates of timely paracentesis in patients admitted with cirrhosis and ascites. While involvement of gastroenterology may increase rates of paracentesis, further efforts are needed to optimize rates of timely paracentesis to positively impact clinical outcomes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 66%

Rates of timely paracentesis for patients admitted to hospital with cirrhosis and ascites remain low but are unaffected by the COVID‐19 pandemic

Aby

Lall

Vasdev

et al. 2022

Journal of Hospital Medicine

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“…We used data from the Veterans Outcomes and Costs Associated with Liver Disease (VOCAL) cohort, derived from the Veterans Affairs (VA) Corporate Data Warehouse-a national database with longitudinal demographic, outpatient and inpatient pharmacy, claims, clinical laboratory, and imaging data on veterans across all 50 states. [12] The VOCAL cohort includes nearly 130,000 veterans diagnosed with cirrhosis from January 1, 2008, to December 31, 2018, and has been the source of many pharmacoepidemiologic studies. Details on cohort creation and cirrhosis identification have been previously published.…”

Section: Study Design and Data Sourcementioning

confidence: 99%

Nonselective beta blockers, hepatic decompensation, and mortality in cirrhosis: A national cohort study

et al. 2022

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Background and Aims: Little is known about the effectiveness of nonselective beta blockers (NSBBs) in preventing hepatic decompensation in routine clinical settings. We investigated whether NSBBs are associated with hepatic decompensation or liver‐related mortality in a national cohort of veterans with Child‐Turcotte‐Pugh (CTP) A cirrhosis with no prior decompensations. Approach and Results: In an active comparator, new user (ACNU) design, we created a cohort of new users of carvedilol (n = 123) versus new users of selective beta blockers (SBBs) (n = 561) and followed patients for up to 3 years. An inverse probability treatment weighting (IPTW) approach balanced demographic and clinical confounders. The primary analysis simulated intention‐to‐treat (“pseudo‐ITT”) with IPTW‐adjusted Cox models; secondary analyses were pseudo‐as‐treated, and both were adjusted for baseline and time‐updating drug confounders. Subgroup analyses evaluated NSBB effects by HCV viremia status, CTP class, platelet count, alcohol‐associated liver disease (ALD) etiology, and age. In pseudo‐ITT analyses of carvedilol versus SBBs, carvedilol was associated with a lower hazard of any hepatic decompensation (HR 0.59, 95% CI 0.42–0.83) and the composite outcome of hepatic decompensation/liver‐related mortality (HR 0.56, 95% CI 0.41–0.76). Results were similar in pseudo‐as‐treated analyses (hepatic decompensation: HR 0.55, 95% CI 0.33–0.94; composite outcome: HR 0.62, 95% 0.38–1.01). In subgroup analyses, carvedilol was associated with lower hazard of primary outcomes in the absence of HCV viremia, higher CTP class and platelet count, younger age, and ALD etiology. Conclusions: There is an ongoing need to noninvasively identify patients who may benefit from NSBBs for the prevention of hepatic decompensation.

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“…Studies were included irrespective of the intent for which they were ordered (2,16). Geographic location of HCC surveillance was categorized as Northeast, Southeast, Mid-South, Central, or West (4,18). Using imaging data beginning in January 7, 2019, the future month where surveillance was due, i.e., due month, was coded on a rolling basis throughout the follow-up window.…”

Section: Study Outcomesmentioning

confidence: 99%

Patterns of Care Utilization and Hepatocellular Carcinoma Surveillance: Tracking Care Across the Pandemic

et al. 2022

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INTRODUCTION:We studied longitudinal trends in mortality, outpatient, and inpatient care for cirrhosis in a national cohort in the first 2 years of the coronavirus disease-2019 pandemic. We evaluated trends in hepatocellular carcinoma (HCC) surveillance and factors associated with completion.METHODS:Within the national cirrhosis cohort in the Veterans Administration from 2020 to 2021, we captured mortality, outpatient primary care provider, gastroenterology/hepatology (GI/HEP) visits, and hospitalizations. HCC surveillance was computed as percentage of time up to date with surveillance every 6 months (PTUDS). Multivariable models for PTUDS were adjusted for patient demographics, clinical factors, and facility-level variables.RESULTS:The total cohort was 68,073; 28,678 were eligible for HCC surveillance. Outpatient primary care provider and GI/HEP appointment rates initially dropped from 30% to 7% with a rebound 1 year into the pandemic and steady subsequent use. Telemedicine monthly visit rates rose from less than 10% to a peak of 20% with a steady gradual decline. Nearly 70% of Veterans were up to date with HCC surveillance before the pandemic with an early pandemic nadir of approximately 50% and 60% PTUDS 2 years into the pandemic. In adjusted models, use of a population-based cirrhosis dashboard (β 8.5, 95% CI 6.9–10.2) and GI/HEP visits both in-person (β 3.2, 95% CI 2.9–3.6) and telemedicine (β 2.1, 95% CI 1.9–2.4) were associated with a higher PTUDS.DISCUSSION:Outpatient utilization and HCC surveillance rates have rebounded but remain below at baseline. Population-based approaches and specialty care for cirrhosis were associated with a higher completion of HCC surveillance.

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Inpatient Gastroenterology Consultation and Outcomes of Cirrhosis-Related Hospitalizations in Two Large National Cohorts

Cited by 9 publications

References 42 publications

Rates of timely paracentesis for patients admitted to hospital with cirrhosis and ascites remain low but are unaffected by the COVID‐19 pandemic

Rates of timely paracentesis for patients admitted to hospital with cirrhosis and ascites remain low but are unaffected by the COVID‐19 pandemic

Nonselective beta blockers, hepatic decompensation, and mortality in cirrhosis: A national cohort study

Patterns of Care Utilization and Hepatocellular Carcinoma Surveillance: Tracking Care Across the Pandemic

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