Mortality and Cost Outcomes of Emergency Department Visits Associated with Primary or Disseminated Liver Cancer in the United States; 2009

Abstract

Specific Aims: To evaluate associations between hospital and patient characteristics and mortality and economic outcomes. Included records were of adult patients age 18 years or older with a diagnosis of primary or disseminated liver cancer. Methods: This study was a retrospective cohort design that utilized emergency department discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) National Emergency Department Sample (NEDS). Generalized linear models were used for analyses to assess outcomes of mortality and total charges. Logistic regression was utilized for mortality; gamma regression with log-link was utilized for charges. Main Results: Overall, 239,895 adult records were included in the study with diagnoses of ICD-9 155.x or 197.7. Total charges for all records were over $8.23 billion in 2009. The average age of the case was 65.07 (±13.8) years with 48.7% being female. Mortality (either in the ED or hospital) was 11.1% (n=26,701). The mean length of stay was 6.47 (±6.05) days. Charges for each record were $42,874.50 (±53,956.34). Increased mortality was associated the most with hospital teaching status and primary payer. Increased charges were associated with hospitals located in the Western region. Conclusions: The differences in clinical outcomes were primarily from different payers and economical outcomes differed greatly by the Western region hospital location. Data taken from the nationally-representative investigation reveals that primary and disseminated liver cancer still remains a clinical high burden-of-illness with an 11.1% mortality rate and total charges approaching $10.3 billion dollars.