Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 16, Number 3, June 2023, pages 171-183

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

Figure 2. Hospital outcomes of patients with nonbleeding esophageal varices versus bleeding esophageal varices. 0 represents nonbleeding esophageal varices and 1 represents bleeding esophageal varices. VNA: visiting nursing assistance.

Figure 3. The trend in the hospitalization outcomes for patients admitted with esophageal varices (part 1). (a) Hospital LOS. (b) Total hospital charges. (c) Hospital mortality. LOS: length of stay.

Figure 4. The trend in the hospitalization outcomes for patients admitted with esophageal varices (part 2). (a) Discharge to rehab. (b) Discharge with visiting nurse. (c) Outside hospital transfer. VNA: visiting nursing assistance.

**Table 1.** Baseline Characteristics
Characteristics	EV without bleeding	EV with bleeding	P value
EV: esophageal varices; SD: standard deviation.
Total number (weighted)	85,959	236,802
Age (mean (SD))	57.83 (11.96)	57.80 (13.52)	0.762
Female (%)	31,390 (36.5)	78,693 (33.2)	< 0.001
Race (%)			< 0.001
White	54,281 (66)	149,284 (66.1)
Black	6,306 (7.7)	17,926 (7.9)
Hispanic	16,621 (20.2)	42,085 (18.6)
Others	5,086 (6.3)	16,459 (7.3)
Expected primary payer (%)			< 0.001
Medicare	35,073 (40.9)	89,665 (38)
Medicaid	20,241 (23.6)	53,690 (22.7)
Private insurance	20,602 (24.0)	56,264 (23.8)
Self-pay/others/no charge	9,787 (11.4)	36,530 (15.5)
Median household income for patients ZIP code (%)			< 0.001
0 to 25th percentile	27,056 (32.4)	79,344 (34.4)
26th to 50th percentile	22,258 (26.6)	61,760 (26.8)
51st to 75th percentile	19,750 (23.6)	52,120 (22.6)
76th to 100th percentile	14,494 (17.3)	37,116 (16.1)
Weighted Elixhauser comorbidity (mean (SD))	16.13 (18.2)	20 (19.78)	< 0.001
Sepsis	1,103 (1.3)	5,805 (2.5)	< 0.001
Acute kidney injury	7,033 (8.2)	43,897 (18.5)	< 0.001
Weekend admissions (%)	18,971 (22.1)	60,791 (25.7)	< 0.001
Location/teaching status of hospital			< 0.001
Rural	13,122 (15.2)	33,243 (14.0)
Urban nonteaching	23,202 (26.9)	69,308 (29.2)
Urban teaching	49,792 (57.8)	134,671 (56.8)
Bed size of the hospital (%)			< 0.001
Small	13,122 (15.2)	33,243 (14.0)
Medium	23,202 (26.9)	69,308 (29.2)
Large	49,792 (57.8)	134,671 (56.8)
Region of the hospital (%)			< 0.001
Northeast	16,077 (18.6)	35,168 (14.8)
Midwest	16,116 (18.7)	40,737 (17.1)
South	33,752 (39.1)	105,821 (44.5)
West	20,300 (23.5)	5,615 (23.6)

Table 1. Baseline Characteristics

Characteristics

EV without bleeding

EV with bleeding

P value

EV: esophageal varices; SD: standard deviation.

Total number (weighted)

85,959

236,802

Age (mean (SD))

57.83 (11.96)

57.80 (13.52)

0.762

Female (%)

31,390 (36.5)

78,693 (33.2)

< 0.001

Race (%)

< 0.001

White

54,281 (66)

149,284 (66.1)

Black

6,306 (7.7)

17,926 (7.9)

Hispanic

16,621 (20.2)

42,085 (18.6)

Others

5,086 (6.3)

16,459 (7.3)

Expected primary payer (%)

< 0.001

Medicare

35,073 (40.9)

89,665 (38)

Medicaid

20,241 (23.6)

53,690 (22.7)

Private insurance

20,602 (24.0)

56,264 (23.8)

Self-pay/others/no charge

9,787 (11.4)

36,530 (15.5)

Median household income for patients ZIP code (%)

< 0.001

0 to 25th percentile

27,056 (32.4)

79,344 (34.4)

26th to 50th percentile

22,258 (26.6)

61,760 (26.8)

51st to 75th percentile

19,750 (23.6)

52,120 (22.6)

76th to 100th percentile

14,494 (17.3)

37,116 (16.1)

Weighted Elixhauser comorbidity (mean (SD))

16.13 (18.2)

20 (19.78)

< 0.001

Sepsis

1,103 (1.3)

5,805 (2.5)

< 0.001

Acute kidney injury

7,033 (8.2)

43,897 (18.5)

< 0.001

Weekend admissions (%)

18,971 (22.1)

60,791 (25.7)

< 0.001

Location/teaching status of hospital

< 0.001

Rural

13,122 (15.2)

33,243 (14.0)

Urban nonteaching

23,202 (26.9)

69,308 (29.2)

Urban teaching

49,792 (57.8)

134,671 (56.8)

Bed size of the hospital (%)

< 0.001

Small

13,122 (15.2)

33,243 (14.0)

Medium

23,202 (26.9)

69,308 (29.2)

Large

49,792 (57.8)

134,671 (56.8)

Region of the hospital (%)

< 0.001

Northeast

16,077 (18.6)

35,168 (14.8)

Midwest

16,116 (18.7)

40,737 (17.1)

South

33,752 (39.1)

105,821 (44.5)

West

20,300 (23.5)

5,615 (23.6)

**Table 2.** Comorbidities of Patients With Esophageal Varices With and Without Bleeding
Comorbidity	EV without bleeding	EV with bleeding	P value
EV: esophageal varices; SD: standard deviation; AIDS: acquired immunodeficiency syndrome; HIV: human immunodeficiency virus.
Weighted Elixhauser score (mean (SD))	16.13 (18.2)	20 (19.78)	< 001
Congestive heart failure (%)	13,686 (15.9)	44,087 (18.6)	< 0.001
Cardiac arrhythmias (%)	17,023 (19.8)	58,266 (24.6)	< 0.001
Valvular heart disease (%)	10,881 (12.7)	34,611 (14.6)	< 0.001
Pulmonary circulation disorders (%)	9,970 (11.6)	32,580 (13.8)	< 0.001
Peripheral vascular disorders (%)	11,032 (12.8)	36,238 (15.3)	< 0.001
Uncomplicated hypertension (%)	40,524 (47.1)	106,297 (44.9)	< 0.001
Complicated hypertension (%)	15,614 (18.2)	49,574 (20.9)	< 0.001
Paralysis (%)	7,273 (8.5)	25,394 (10.7)	< 0.001
Other neurological disorders (%)	12,296 (14.3)	45,828 (19.4)	< 0.001
Chronic pulmonary disease (%)	21,949 (25.5)	59,993 (25.3)	0.717
Uncomplicated diabetes (%)	27,834 (32.4)	76,129 (32.1)	0.67
Complicated diabetes (%)	17,474 (20.3)	48,838 (20.6)	0.586
Hypothyroidism (%)	17,514 (20.4)	49,443 (20.9)	0.354
Renal failure (%)	16,493 (19.2)	52,400 (22.1)	< 0.001
Liver disease (%)	85,959 (100)	207,942 (87.8)	< 0.001
Peptic ulcer disease (%)	11,560 (13.4)	40,648 (17.2)	< 0.001
AIDS/HIV (%)	5,459 (6.4)	18,627 (7.9)	0.001
Lymphoma (%)	5,539 (6.4)	22,604 (9.5)	< 0.001
Metastatic cancer (%)	8,478 (9.9)	34,028 (14.4)	< 0.001
Solid tumor without metastasis (%)	12,018 (14)	44,755 (18.9)	< 0.001
Rheumatic disease (%)	9,825 (11.4)	32,968 (13.9)	< 0.001
Coagulopathy (%)	37,934 (44.1)	120,617 (50.9)	< 0.001
Obesity (%)	17,217 (20)	47,954 (20.3)	0.684
Weight loss (%)	12,230 (14.2)	50,634 (21.4)	< 0.001
Fluid and electrolytes disorders (%)	32,524 (37.8)	116,208 (49.1)	< 0.001
Blood loss anemia (%)	12,143 (14.1)	49,675 (21)	< 0.001
Deficiency anemia (%)	15,883 (18.5)	40,592 (17.1)	0.015
Alcohol abuse	49,894 (58)	142,227 (60.1)	< 0.001
Drug abuse (%)	14,397 (16.7)	45,745 (19.3)	< 0.001
Psychoses (%)	9,198 (10.7)	30,960 (13.1)	< 0.001
Depression (%)	21,209 (24.7)	54,712 (23.1)	0.004

Table 2. Comorbidities of Patients With Esophageal Varices With and Without Bleeding

Comorbidity

EV without bleeding

EV with bleeding

P value

EV: esophageal varices; SD: standard deviation; AIDS: acquired immunodeficiency syndrome; HIV: human immunodeficiency virus.

Weighted Elixhauser score (mean (SD))

16.13 (18.2)

20 (19.78)

< 001

Congestive heart failure (%)

13,686 (15.9)

44,087 (18.6)

< 0.001

Cardiac arrhythmias (%)

17,023 (19.8)

58,266 (24.6)

< 0.001

Valvular heart disease (%)

10,881 (12.7)

34,611 (14.6)

< 0.001

Pulmonary circulation disorders (%)

9,970 (11.6)

32,580 (13.8)

< 0.001

Peripheral vascular disorders (%)

11,032 (12.8)

36,238 (15.3)

< 0.001

Uncomplicated hypertension (%)

40,524 (47.1)

106,297 (44.9)

< 0.001

Complicated hypertension (%)

15,614 (18.2)

49,574 (20.9)

< 0.001

Paralysis (%)

7,273 (8.5)

25,394 (10.7)

< 0.001

Other neurological disorders (%)

12,296 (14.3)

45,828 (19.4)

< 0.001

Chronic pulmonary disease (%)

21,949 (25.5)

59,993 (25.3)

0.717

Uncomplicated diabetes (%)

27,834 (32.4)

76,129 (32.1)

0.67

Complicated diabetes (%)

17,474 (20.3)

48,838 (20.6)

0.586

Hypothyroidism (%)

17,514 (20.4)

49,443 (20.9)

0.354

Renal failure (%)

16,493 (19.2)

52,400 (22.1)

< 0.001

Liver disease (%)

85,959 (100)

207,942 (87.8)

< 0.001

Peptic ulcer disease (%)

11,560 (13.4)

40,648 (17.2)

< 0.001

AIDS/HIV (%)

5,459 (6.4)

18,627 (7.9)

0.001

Lymphoma (%)

5,539 (6.4)

22,604 (9.5)

< 0.001

Metastatic cancer (%)

8,478 (9.9)

34,028 (14.4)

< 0.001

Solid tumor without metastasis (%)

12,018 (14)

44,755 (18.9)

< 0.001

Rheumatic disease (%)

9,825 (11.4)

32,968 (13.9)

< 0.001

Coagulopathy (%)

37,934 (44.1)

120,617 (50.9)

< 0.001

Obesity (%)

17,217 (20)

47,954 (20.3)

0.684

Weight loss (%)

12,230 (14.2)

50,634 (21.4)

< 0.001

Fluid and electrolytes disorders (%)

32,524 (37.8)

116,208 (49.1)

< 0.001

Blood loss anemia (%)

12,143 (14.1)

49,675 (21)

< 0.001

Deficiency anemia (%)

15,883 (18.5)

40,592 (17.1)

0.015

Alcohol abuse

49,894 (58)

142,227 (60.1)

< 0.001

Drug abuse (%)

14,397 (16.7)

45,745 (19.3)

< 0.001

Psychoses (%)

9,198 (10.7)

30,960 (13.1)

< 0.001

Depression (%)

21,209 (24.7)

54,712 (23.1)

0.004

**Table 3.** Baseline Characteristics for Hospitalized Patients With Esophageal Varices From 2011 to 2018
Year	2011	2012	2013	2014	2015	2016	2017	2018	P value
SD: standard deviation.
Total number (weighted)	37,381	37,045	38,150	37,480	41,970	44,760	41,670	44,305
Esophageal varices (%)									< 0.001
With bleeding	29,187 (78.1)	29,090 (78.5)	29,545 (77.4)	27,790 (74.1)	31,515 (75.1)	29,990 (67)	28,340 (68)	31,345 (70.7)
Without bleeding	819 (21.9)	7,955 (21.5)	8,605 (22.6)	9,690 (25.9)	10,455 (24.9)	14,770 (33)	13,330 (32)	12,960 (29.3)
Age (mean (SD))	58.65 (14.25)	58.27 (13.82)	58.49 (13.62)	58.49 (13.36)	57.97 (13.13)	56.93 (129)	56.92 (12.36)	57.10 (12.43)	< 0.001
Female (%)	12,968.1 (34.7)	12,685 (34.2)	12,925 (33.9)	12,910 (34.5)	14,330 (34.2)	15,125 (33.8)	14,275 (34.3)	14,865 (33.6)	0.877
Race (%)									< 0.001
White	23,284.3 (67.6)	23,830 (67.7)	24,490 (67.8)	24,095 (67.6)	26,265 (65.6)	27,545 (64.2)	26,160 (64.8)	27,895 (64.3)
Black	3,056.8 (8.9)	2,990 (8.5)	3,380 (9.4)	3,110 (8.7)	3,210 (8)	3,150 (7.3)	2,510 (6.2)	2,825 (6.5)
Hispanic	6,161.4 (17.9)	5,815 (16.5)	5,895 (16.3)	6,100 (17.1)	7,780 (19.4)	9,105 (21.2)	8,815 (21.9)	9,035 (20.8)
Others	1,939.1 (5.6)	2,540 (7.2)	2,370 (6.6)	2,360 (6.6)	2,785 (7)	3,100 (7.2)	2,855 (7.1)	3,595 (8.3)
Expected primary payer (%)									< 0.001
Medicare	15,342.9 (41.2)	15,555 (42.1)	16,000 (42)	15,410 (41.3)	16,270 (38.9)	15,880 (35.5)	14,520 (34.9)	15,760 (35.7)
Medicaid	6,716.2 (18.1)	6,950 (18.8)	7,375 (19.4)	8,245 (22.1)	10,265 (24.5)	11,785 (26.4)	11,010 (26.5)	11,585 (26.2)
Private insurance	8,790.8 (23.6)	8,070 (21.9)	8,195 (21.5)	8,580 (23)	10,270 (24.5)	11,400 (25.5)	10,450 (25.1)	11,110 (25.1)
Self-pay/others	6,356.5 (17.1)	6,340 (17.2)	6,515 (17.1)	5,120 (13.7)	5,065 (12.1)	5,610 (12.6)	5,580 (13.4)	5,730 (13)
Median household income for patients ZIP code (%)									< 0.010
0 to 25th percentile	11,739.7 (32.2)	12,720 (35.4)	12,735 (34.4)	12,320 (33.9)	14,015 (34.4)	15,300 (35.1)	13,770 (33.9)	13,800 (32.1)
26th to 50th percentile	9,588.2 (26.3)	9,220 (25.6)	10,015 (27)	10,545 (29)	10,250 (25.1)	11,250 (25.8)	10,880 (26.8)	12,270 (28.5)
51st to 75th percentile	8,890.8 (24.4)	8,015 (22.3)	8,600 (23.2)	7,695 (21.1)	9,440 (23.2)	9,715 (22.3)	9,770 (24.1)	9,745 (22.6)
76th to 100th percentile	6,279.7 (17.2)	6,005 (16.7)	5,685 (15.4)	5,825 (16)	7,070 (17.3)	7,385 (16.9)	6,140 (15.1)	7,220 (16.8)
Sepsis	447.9 (1.2)	425 (1.1)	465 (1.2)	540 (1.4)	820 (2)	1,495 (3.3)	1195 (2.9)	1,520 (3.4)	< 0.001
Acute kidney injury	5,108.8 (13.7)	5,555 (15)	6,220 (16.3)	6,190 (16.5)	6,910 (16.5)	6,840 (15.3)	6,425 (15.4)	7,505 (16.9)	< 0.001
Location/teaching status of hospital									< 0.001
Rural	3,148.1 (8.6)	3,200 (8.6)	3,650 (9.6)	2,675 (7.1)	2,495 (5.9)	2,895 (6.5)	2,730 (6.6)	2,600 (5.9)
Urban nonteaching	16,043.2 (43.8)	13,905 (37.5)	14,225 (37.3)	9,980 (26.6)	11,530 (27.5)	12,205 (27.3)	9,855 (23.7)	9,185 (20.7)
Urban teaching	17,427.2 (47.6)	19,940 (53.8)	20,275 (53.1)	24,825 (66.2)	27,945 (66.6)	29,660 (66.3)	29,085 (69.8)	32,520 (73.4)
Bed size of the hospital (%)									< 0.001
Small	2,934.4 (8)	4,210 (11.4)	4,065 (10.7)	6,130 (16.4)	6,440 (15.3)	7,245 (16.2)	7,065 (17)	8,000 (18.1)
Medium	8,728.8 (23.8)	10,420 (28.1)	10,650 (27.9)	11,060 (29.5)	12,510 (29.8)	13,260 (29.6)	12,705 (30.5)	12,860 (29)
Large	24,955.4 (68.1)	22,415 (60.5)	23,435 (61.4)	20,290 (54.1)	23,020 (54.8)	24,255 (54.2)	21,900 (52.6)	23,445 (52.9)
Region of the hospital (%)									< 0.001
Northeast	6,398.9 (17.1)	6,340 (17.1)	6,530 (17.1)	6,310 (16.8)	6,665 (15.9)	7,020 (15.7)	4,520 (10.8)	7,090 (16)
Midwest	7,988.2 (21.4)	6,230 (16.8)	6,540 (17.1)	6,730 (18)	6,570 (15.7)	7,380 (16.5)	7,630 (18.3)	7,460 (16.8)
South	15,663.1 (41.9)	16,660 (45)	17,260 (45.2)	16,945 (45.2)	17,005 (40.5)	19,115 (42.7)	18,265 (43.8)	18,260 (41.2)
West	7,330.6 (19.6)	7,815 (21.1)	7,820 (20.5)	7,495 (20)	11,730 (27.9)	11,245 (25.1)	11,255 (27)	11,495 (25.9)

Table 3. Baseline Characteristics for Hospitalized Patients With Esophageal Varices From 2011 to 2018

Year

2011

2012

2013

2014

2015

2016

2017

2018

P value

SD: standard deviation.

Total number (weighted)

37,381

37,045

38,150

37,480

41,970

44,760

41,670

44,305

Esophageal varices (%)

< 0.001

With bleeding

29,187 (78.1)

29,090 (78.5)

29,545 (77.4)

27,790 (74.1)

31,515 (75.1)

29,990 (67)

28,340 (68)

31,345 (70.7)

Without bleeding

819 (21.9)

7,955 (21.5)

8,605 (22.6)

9,690 (25.9)

10,455 (24.9)

14,770 (33)

13,330 (32)

12,960 (29.3)

Age (mean (SD))

58.65 (14.25)

58.27 (13.82)

58.49 (13.62)

58.49 (13.36)

57.97 (13.13)

56.93 (129)

56.92 (12.36)

57.10 (12.43)

< 0.001

Female (%)

12,968.1 (34.7)

12,685 (34.2)

12,925 (33.9)

12,910 (34.5)

14,330 (34.2)

15,125 (33.8)

14,275 (34.3)

14,865 (33.6)

0.877

Race (%)

< 0.001

White

23,284.3 (67.6)

23,830 (67.7)

24,490 (67.8)

24,095 (67.6)

26,265 (65.6)

27,545 (64.2)

26,160 (64.8)

27,895 (64.3)

Black

3,056.8 (8.9)

2,990 (8.5)

3,380 (9.4)

3,110 (8.7)

3,210 (8)

3,150 (7.3)

2,510 (6.2)

2,825 (6.5)

Hispanic

6,161.4 (17.9)

5,815 (16.5)

5,895 (16.3)

6,100 (17.1)

7,780 (19.4)

9,105 (21.2)

8,815 (21.9)

9,035 (20.8)

Others

1,939.1 (5.6)

2,540 (7.2)

2,370 (6.6)

2,360 (6.6)

2,785 (7)

3,100 (7.2)

2,855 (7.1)

3,595 (8.3)

Expected primary payer (%)

< 0.001

Medicare

15,342.9 (41.2)

15,555 (42.1)

16,000 (42)

15,410 (41.3)

16,270 (38.9)

15,880 (35.5)

14,520 (34.9)

15,760 (35.7)

Medicaid

6,716.2 (18.1)

6,950 (18.8)

7,375 (19.4)

8,245 (22.1)

10,265 (24.5)

11,785 (26.4)

11,010 (26.5)

11,585 (26.2)

Private insurance

8,790.8 (23.6)

8,070 (21.9)

8,195 (21.5)

8,580 (23)

10,270 (24.5)

11,400 (25.5)

10,450 (25.1)

11,110 (25.1)

Self-pay/others

6,356.5 (17.1)

6,340 (17.2)

6,515 (17.1)

5,120 (13.7)

5,065 (12.1)

5,610 (12.6)

5,580 (13.4)

5,730 (13)

Median household income for patients ZIP code (%)

< 0.010

0 to 25th percentile

11,739.7 (32.2)

12,720 (35.4)

12,735 (34.4)

12,320 (33.9)

14,015 (34.4)

15,300 (35.1)

13,770 (33.9)

13,800 (32.1)

26th to 50th percentile

9,588.2 (26.3)

9,220 (25.6)

10,015 (27)

10,545 (29)

10,250 (25.1)

11,250 (25.8)

10,880 (26.8)

12,270 (28.5)

51st to 75th percentile

8,890.8 (24.4)

8,015 (22.3)

8,600 (23.2)

7,695 (21.1)

9,440 (23.2)

9,715 (22.3)

9,770 (24.1)

9,745 (22.6)

76th to 100th percentile

6,279.7 (17.2)

6,005 (16.7)

5,685 (15.4)

5,825 (16)

7,070 (17.3)

7,385 (16.9)

6,140 (15.1)

7,220 (16.8)

Sepsis

447.9 (1.2)

425 (1.1)

465 (1.2)

540 (1.4)

820 (2)

1,495 (3.3)

1195 (2.9)

1,520 (3.4)

< 0.001

Acute kidney injury

5,108.8 (13.7)

5,555 (15)

6,220 (16.3)

6,190 (16.5)

6,910 (16.5)

6,840 (15.3)

6,425 (15.4)

7,505 (16.9)

< 0.001

Location/teaching status of hospital

< 0.001

Rural

3,148.1 (8.6)

3,200 (8.6)

3,650 (9.6)

2,675 (7.1)

2,495 (5.9)

2,895 (6.5)

2,730 (6.6)

2,600 (5.9)

Urban nonteaching

16,043.2 (43.8)

13,905 (37.5)

14,225 (37.3)

9,980 (26.6)

11,530 (27.5)

12,205 (27.3)

9,855 (23.7)

9,185 (20.7)

Urban teaching

17,427.2 (47.6)

19,940 (53.8)

20,275 (53.1)

24,825 (66.2)

27,945 (66.6)

29,660 (66.3)

29,085 (69.8)

32,520 (73.4)

Bed size of the hospital (%)

< 0.001

Small

2,934.4 (8)

4,210 (11.4)

4,065 (10.7)

6,130 (16.4)

6,440 (15.3)

7,245 (16.2)

7,065 (17)

8,000 (18.1)

Medium

8,728.8 (23.8)

10,420 (28.1)

10,650 (27.9)

11,060 (29.5)

12,510 (29.8)

13,260 (29.6)

12,705 (30.5)

12,860 (29)

Large

24,955.4 (68.1)

22,415 (60.5)

23,435 (61.4)

20,290 (54.1)

23,020 (54.8)

24,255 (54.2)

21,900 (52.6)

23,445 (52.9)

Region of the hospital (%)

< 0.001

Northeast

6,398.9 (17.1)

6,340 (17.1)

6,530 (17.1)

6,310 (16.8)

6,665 (15.9)

7,020 (15.7)

4,520 (10.8)

7,090 (16)

Midwest

7,988.2 (21.4)

6,230 (16.8)

6,540 (17.1)

6,730 (18)

6,570 (15.7)

7,380 (16.5)

7,630 (18.3)

7,460 (16.8)

South

15,663.1 (41.9)

16,660 (45)

17,260 (45.2)

16,945 (45.2)

17,005 (40.5)

19,115 (42.7)

18,265 (43.8)

18,260 (41.2)

West

7,330.6 (19.6)

7,815 (21.1)

7,820 (20.5)

7,495 (20)

11,730 (27.9)

11,245 (25.1)

11,255 (27)

11,495 (25.9)

**Table 4.** Outcomes
Outcomes/year		2011	2012	2013	2014	2015	2016	2017	2018
LOS: length of stay; EV: esophageal varices; VNA: visiting nursing assistance; CI: confidence interval.
LOS (days) (mean (95% CI))	EVs with bleeding	5.27 (5.11 - 5.44)	5.3 (5.15 - 5.44)	5.3 (5.15 - 5.45)	5.25, (5.11 - 5.39)	5.17 (5.03 - 5.3)	5.24 (5.1 - 5.38)	4.91 (4.79 - 5.03)	5.1 (4.96 - 5.24)
	EVs without bleeding	3.94 (3.68 - 4.21)	3.85 (3.67 - 4.02)	3.82 (3.59 - 4.05)	3.99, (3.83 - 4.16)	3.76 (3.61 - 3.91)	3.87 (3.74 - 4.01)	3.87 (3.7 - 4.03)	3.82 (3.67 - 3.97)
Hospital charges ($) (mean (95% CI))	EVs with bleeding	51,839.98 (48,578.07 - 55,101.89)	53,953.48 (51,555.32 - 56,351.64)	55,633.86 (53,211.07 - 58,056.64)	54,912.26, (52,501.92 - 57,322.6)	63,297.49 (60,677.55 - 65,917.43)	70,114.39 (67,114.6 - 73,114.19)	67,328.94 (64,821.58 - 69,836.3)	71,473.25 (68,378.91 - 74,567.59)
	EVs without bleeding	35,827.21 (30,163.75 - 41,490.67)	35,649.92, (32,773.95 - 38,525.9)	36,773.85 (34,042.04 - 39,505.66)	37,672.14, (35,165.29 - 40,179)	37,029.87 (34,889.26 - 39,170.47)	41,856.72 (39,690.38 - 44,023.05)	41,756.69 (39,579.09 - 43,934.29)	43,452.13 (40630.1 - 46,274.15)
Hospital mortality (odds (95% CI))	EVs with bleeding	0.049 (0.043 - 0.055)	0.055 (0.049 - 0.062)	0.057 (0.051 - 0.064)	0.049 (0.043 - 0.056)	0.06 (0.054 - 0.067)	0.068 (0.062 - 0.076)	0.058 (0.051 - 0.065)	0.059 (0.053 - 0.066)
	EVs without bleeding	0.008 (0.005 - 0.014)	0.006 (0.003 - 0.012)	0.006 (0.003 - 0.011)	0.004 (0.002 - 0.008)	0.004 (0.002 - 0.008)	0.005 (0.003 - 0.009)	0.003 (0.002 - 0.006)	0.004 (0.002 - 0.007)
Discharge to rehab (odds (95% CI))	EVs with bleeding	0.219 (0.2 - 0.24)	0.215 (0.198 - 0.233)	0.206 (0.19 - 0.224)	0.196 (0.18 - 0.213)	0.176 (0.163 - 0.191)	0.105 (0.095 - 0.116)	0.106 (0.095 - 0.117)	0.098 (0.088 - 0.109)
	EVs without bleeding	0.102 (0.084 - 0.122)	0.118 (0.099 - 0.141)	0.099 (0.081 - 0.12)	0.127 (0.109 - 0.149)	0.119 (0.102 - 0.14)	0.113 (0.099 - 0.129)	0.113 (0.098 - 0.13)	0.109 (0.095 - 0.126)
Discharge with VNA (odds (95% CI))	EVs with bleeding	0.132 (0.118 - 0.147)	0.129 (0.116 - 0.143)	0.135 (0.122 - 0.148)	0.134 (0.121 - 0.148)	0.13 (0.118 - 0.142)	0.114 (0.103 - 0.125	0.116 (0.105 - 0.129)	0.12 (0.109 - 0.132)
	EVs without bleeding	0.113 (0.092 - 0.139)	0.129 (0.109 - 0.152)	0.157 (0.135 - 0.182)	0.156 (0.136 - 0.179)	0.146 (0.125 - 0.17)	0.142 (0.125 - 0.161)	0.145 (0.127 - 0.164)	0.163 (0.143 - 0.186)
Transfer other hospital (odds (95% CI))	EVs with bleeding	0.055 (0.046 - 0.064)	0.049 (0.042 - 0.057)	0.053 (0.046 - 0.061)	0.044 (0.037 - 0.051)	0.051 (0.044 - 0.059)	0.053 (0.046 - 0.061)	0.055 (0.047 - 0.063)	0.061 (0.054 - 0.07)
	EVs without bleeding	0.032 (0.023 - 0.043)	0.023 (0.016 - 0.033)	0.025 (0.018 - 0.036)	0.033 (0.024 - 0.044)	0.031 (0.024 - 0.039)	0.022 (0.017 - 0.03)	0.03 (0.023 - 0.039)	0.03 (0.023 - 0.039)

Table 4. Outcomes

Outcomes/year

2011

2012

2013

2014

2015

2016

2017

2018

LOS: length of stay; EV: esophageal varices; VNA: visiting nursing assistance; CI: confidence interval.

LOS (days) (mean (95% CI))

EVs with bleeding

5.27 (5.11 - 5.44)

5.3 (5.15 - 5.44)

5.3 (5.15 - 5.45)

5.25, (5.11 - 5.39)

5.17 (5.03 - 5.3)

5.24 (5.1 - 5.38)

4.91 (4.79 - 5.03)

5.1 (4.96 - 5.24)

EVs without bleeding

3.94 (3.68 - 4.21)

3.85 (3.67 - 4.02)

3.82 (3.59 - 4.05)

3.99, (3.83 - 4.16)

3.76 (3.61 - 3.91)

3.87 (3.74 - 4.01)

3.87 (3.7 - 4.03)

3.82 (3.67 - 3.97)

Hospital charges ($) (mean (95% CI))

EVs with bleeding

51,839.98 (48,578.07 - 55,101.89)

53,953.48 (51,555.32 - 56,351.64)

55,633.86 (53,211.07 - 58,056.64)

54,912.26, (52,501.92 - 57,322.6)

63,297.49 (60,677.55 - 65,917.43)

70,114.39 (67,114.6 - 73,114.19)

67,328.94 (64,821.58 - 69,836.3)

71,473.25 (68,378.91 - 74,567.59)

EVs without bleeding

35,827.21 (30,163.75 - 41,490.67)

35,649.92, (32,773.95 - 38,525.9)

36,773.85 (34,042.04 - 39,505.66)

37,672.14, (35,165.29 - 40,179)

37,029.87 (34,889.26 - 39,170.47)

41,856.72 (39,690.38 - 44,023.05)

41,756.69 (39,579.09 - 43,934.29)

43,452.13 (40630.1 - 46,274.15)

Hospital mortality (odds (95% CI))

EVs with bleeding

0.049 (0.043 - 0.055)

0.055 (0.049 - 0.062)

0.057 (0.051 - 0.064)

0.049 (0.043 - 0.056)

0.06 (0.054 - 0.067)

0.068 (0.062 - 0.076)

0.058 (0.051 - 0.065)

0.059 (0.053 - 0.066)

EVs without bleeding

0.008 (0.005 - 0.014)

0.006 (0.003 - 0.012)

0.006 (0.003 - 0.011)

0.004 (0.002 - 0.008)

0.005 (0.003 - 0.009)

0.003 (0.002 - 0.006)

0.004 (0.002 - 0.007)

Discharge to rehab (odds (95% CI))

EVs with bleeding

0.219 (0.2 - 0.24)

0.215 (0.198 - 0.233)

0.206 (0.19 - 0.224)

0.196 (0.18 - 0.213)

0.176 (0.163 - 0.191)

0.105 (0.095 - 0.116)

0.106 (0.095 - 0.117)

0.098 (0.088 - 0.109)

EVs without bleeding

0.102 (0.084 - 0.122)

0.118 (0.099 - 0.141)

0.099 (0.081 - 0.12)

0.127 (0.109 - 0.149)

0.119 (0.102 - 0.14)

0.113 (0.099 - 0.129)

0.113 (0.098 - 0.13)

0.109 (0.095 - 0.126)

Discharge with VNA (odds (95% CI))

EVs with bleeding

0.132 (0.118 - 0.147)

0.129 (0.116 - 0.143)

0.135 (0.122 - 0.148)

0.134 (0.121 - 0.148)

0.13 (0.118 - 0.142)

0.114 (0.103 - 0.125

0.116 (0.105 - 0.129)

0.12 (0.109 - 0.132)

EVs without bleeding

0.113 (0.092 - 0.139)

0.129 (0.109 - 0.152)

0.157 (0.135 - 0.182)

0.156 (0.136 - 0.179)

0.146 (0.125 - 0.17)

0.142 (0.125 - 0.161)

0.145 (0.127 - 0.164)

0.163 (0.143 - 0.186)

Transfer other hospital (odds (95% CI))

EVs with bleeding

0.055 (0.046 - 0.064)

0.049 (0.042 - 0.057)

0.053 (0.046 - 0.061)

0.044 (0.037 - 0.051)

0.051 (0.044 - 0.059)

0.053 (0.046 - 0.061)

0.055 (0.047 - 0.063)

0.061 (0.054 - 0.07)

EVs without bleeding

0.032 (0.023 - 0.043)

0.023 (0.016 - 0.033)

0.025 (0.018 - 0.036)

0.033 (0.024 - 0.044)

0.031 (0.024 - 0.039)

0.022 (0.017 - 0.03)

0.03 (0.023 - 0.039)