Hospital Teaching Status on Mortality, Length of Stay, and Cost Amongst Patients With Primary Biliary Cholangitis

Abstract

Introduction: Primary biliary cholangitis (PBC) is a complex immune-mediated disease that may be more suitably treated in high-volume teaching hospitals. Past studies have recognized a positive relationship between large teaching institutions and lower mortality rates for many conditions, however to the best of our knowledge, such has not been shown in the case of PBC. Our study seeks to assess the variance in mortality, cost of care, and length of stay amongst patients with PBC in teaching and nonteaching institutions. Methods: Data from the Nationwide Inpatient Sample (NIS) between the years 2005-2011 was examined for the purposes of this retrospective study. We identified all adult patients ≥ 18 years old with a primary or secondary discharge diagnosis of PBC. Descriptive statistics in addition to linear and polynomial regression was employed to analyze trends. A p-value a < 0.05 was considered statistically significant. Results: The in-hospital mortality rate in non-teaching institutions decreased from 3.66% in 2005 to 2.80% in 2011 [P < 0.001, fig. 1A]. Remarkably, teaching institutions demonstrated no statistically significant difference in inpatient mortality between this 7-year period [P > 0.05, fig. 1A]. Additionally, the average mortality rate was 4.64% in teaching hospitals vs. 3.68% in non-teaching hospitals. The mean cost of care increased in both settings with an average of $55,893 in teaching hospitals as compared to $35,338 in non-teaching hospitals [adjusted for inflation, P < 0.05, fig. 1B]. Length of stay (LOS) demonstrated a downward trend in non-teaching hospitals [P < 0.01], whereas teaching institutions proved to have no statistically significant change [P > 0.05, fig. 1C]. Moreover, average LOS amongst teaching hospitals was 6.76 days, 1.3 days more than in non-teaching hospitals. Conclusion: Our analysis of the NIS database demonstrated a decrease in the mortality rate and LOS amongst patients admitted to non-teaching hospitals. Contrary to what instinct may suggest, teaching hospitals demonstrated no statistically significant decline in mortality rate or LOS. Additionally, the mean mortality rate was higher in teaching hospitals when compared to non-teaching hospitals (OR 1.26). This may possibly be attributed to the fact that teaching institutions often encounter more severe or advanced cases that are referred from non-teaching hospitals. Additional multicenter studies are required to elucidate the mechanism responsible for our observations.30_A Figure 1. No Caption available.