Deleterious Effect of Cirrhosis on Outcomes After Motor Vehicle Crashes Using the Nationwide Inpatient Sample

Abstract

Alcohol abuse and minimal hepatic encephalopathy may predispose cirrhotics to a higher motor vehicle crash (MVC) rate. Cirrhotics have poor post-trauma outcomes on small-scale studies. The aim was to examine the effect of cirrhosis on mortality, charges, and length of stay (LOS) after MVCs using the Nationwide Inpatient Sample (NIS) 2004. NIS 2004 was queried for cirrhotics with MVC (C-MVC), cirrhotics only, and MVC only for demographics, comorbidities, hospital characteristics, and the Injury Severity Score (ISS). C-MVC patients were compared with the other groups. Weighted uni/multivariate regression was performed for all MVCs (with/without cirrhosis). There were 560,080 discharges for cirrhosis only, 262,244 for MVC only, and 1,565 for C-MVC. C-MVC patients were significantly younger (49.8 yr vs 58.6 yr, P < 0.0005) and had less comorbidities than cirrhosis only, but had similar mortality (C-MVC 10.8% vs cirrhosis only 9.9%, P= 0.23). C-MVC patients (49.8 yr) were older than MVC only patients (43.7 yr, P < 0.0005). C-MVC patients also had significantly higher mortality (10.8%) compared with MVC only (3.1%, P < 0.0005) despite similar ISS. C-MVC patients had significantly greater LOS (9.6 days) and charges ($67,119) compared with both MVC only (6.2 days, $43,314) and cirrhosis only (7.4 days, $35,522). Cirrhosis (odds ratio [OR] 3.5, 95% confidence interval [CI] 2.5-5.5) and age >65 yr (OR 5.2, 95% CI 4.4-6.0) were most commonly associated with mortality. Male sex, high ISS, self-pay, teaching, and large and urban hospitals were also significantly associated with mortality. On multivariate regression, cirrhosis was associated with greater charges and LOS. Cirrhosis is associated with greater mortality, LOS, and charges after MVC despite controlling for injury severity, comorbidities, and age in NIS 2004.