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Hospitalization Trends Due to Chronic Liver Diseases: Vicious Circle of Co-Morbidities and Hospitalization Length
Ivana Pantic1, Nikola Grubor2, Sofija Lugonja3
1Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, St. Dr Koste Todorovica 2, 11000 Belgrade, Serbia.
Insights
Chronic liver diseases (CLD) significantly impact hospitalization length. Managing co-morbidities and cirrhosis is crucial for reducing hospital stays and healthcare costs.
Area of Science:
- Hepatology
- Public Health
- Biostatistics
Background:
- Chronic liver diseases (CLD) pose a significant healthcare burden, often exacerbated by late diagnosis and multiple co-morbidities.
- Understanding factors influencing hospitalization duration is key to optimizing patient care and resource allocation.
- This study investigates the impact of co-morbidities, cirrhosis, and disease etiology on length of stay (LOS) for CLD patients.
Purpose of the Study:
- To evaluate the effect of co-morbidities, cirrhosis, and disease etiology on hospitalization duration in chronic liver disease patients.
- To analyze hospitalization trends and identify key determinants of length of stay (LOS).
- To provide evidence for earlier detection and better management of CLD and its co-morbidities.
Main Methods:
- Retrospective analysis of hospitalizations for alcohol-related, viral, autoimmune, and overlapping liver diseases in Belgrade, Serbia (2016-2022).
- Descriptive analysis of hospitalization trends using relative mean change in LOS over time.
- Causal effect estimation of diagnosis type on LOS using Bayesian distributional lognormal models and post hoc analysis of cirrhosis impact.
Main Results:
- Average LOS decreased from 8.25 to 5.51 days; median LOS decreased from 4 to 1 day between 2016-2022.
- Autoimmune liver disease (15.89 days) and alcohol-related liver disease (14.22 days) showed the highest expected LOS.
- Cirrhosis had the most significant impact on LOS for viral liver disease patients (4.19 days).
Conclusions:
- Co-morbidities and cirrhosis significantly influence the length of hospital stay for chronic liver disease patients.
- Earlier detection of liver disease and improved management of co-morbidities are essential for reducing healthcare costs.
- Targeted interventions based on disease etiology and presence of cirrhosis can optimize patient management and resource utilization.
Abstract:
Background and Aims: Chronic liver diseases (CLD) represent a significant healthcare burden, mostly due to late diagnosis and numerous co-morbidities. We evaluated the effect of co-morbidities, cirrhosis, and disease etiology on hospitalization duration. Methods: Hospitalizations due to alcohol-related, viral, autoimmune, and overlapping liver disease in Belgrade, Serbia (2016-2022), were identified using pre-defined discharge codes. We investigated the hospitalization trend descriptively by plotting the relative mean change in the hospitalization length against time. Assuming the covariate relationship in the directed acyclic graph, we estimated the direct causal effect of the diagnosis type on the length of stay (LOS) by fitting pre-specified Bayesian distributional lognormal models based on domain knowledge. We conducted a post hoc analysis of the impact of cirrhosis on LOS per primary diagnosis. Results: The empirical data show a decrease in the estimated average LOS (8.25-5.51 days). For the same period, the median LOS decreased (4 days (IQR 0-12) to 1 day (IQR 1-7)). In 2021, the share of short-term hospitalizations rose to 46.94%, while the median long-term hospitalization peaked at 11.5 days (IQR 7-21). The expected LOS was the highest for the primary diagnosis of autoimmune liver disease (15.89, 95% CI [14.74, 17.2] days), followed by alcohol-related liver disease (14.22, 95% CI [13.68, 14.79] days). The largest impact of cirrhosis on LOS was observed among patients hospitalized due to viral disease (4.19, 95% CI [2.29, 6.33] days). Conclusions: The presence of co-morbidities and cirrhosis significantly affects LOS. In order to provide better treatment and reduce healthcare costs, there is the need to detect liver disease at earlier stages and better manage its associated co-morbidities.
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