S1280 Comparing Outcomes of Decompensated Cirrhosis Management on a Primary Hepatologist-Managed Service versus a Hospitalist-Managed Service at an Urban Hospital

Introduction: While there are treatment guidelines for management of decompensated cirrhosis, limited data exist about adherence to specific quality measures and whether adherence differs based on specialty training (hospitalists versus hepatologists). We aimed to compare outcomes of quality-based practices of hepatology-led versus hospitalist-led services for admissions for management of decompensated cirrhosis. Methods: 2,009 admissions of patients presenting to our institution with a diagnosis of decompensated cirrhosis from 2016 to 2020 were retrospectively reviewed. 547 admissions of patients admitted for management of hepatic encephalopathy (HE), ascites, bleeding esophageal varices (EV), hepatorenal syndrome (HRS), or spontaneous bacterial peritonitis (SBP) were included. Patients were grouped based on service at the time of discharge: hepatology service (HH), hospitalist service (GM), or hospitalist service with hepatology consult (MH). Quality indicators assessed included admission length of stay, intensive care unit (ICU) admission, and death. Stat was used for statistical analysis. Results: Of the 547 admissions included, 168 admissions were on GM, 178 on MH, and 201on HH services. On average, GM patients were younger compared to their MH and HH counterparts (56.1, 59.2, 59.1 years respectively, p = 0.02). Additionally average MELD score at admission was higher on GM (23.1) compared to MH (17.6) and HH (20.3; p< 0.001) services. This was similarly reflected in the Child-Pugh Score at admission [GM (10.3), MH (8.9), and HH (9.6; p< 0.001)]. GM admissions had a longer hospital stay (9.1 days) compared to HH (6.2 days; p< 0.001) admissions, which remained significant when controlling for MELD score and age (p=0.001). GM admissions had a lower incidence of ICU transfers compared to MH and HH (27.2%, 34.8%, 38.0% respectively; p = 0.007). Patients on MH were less likely to expire prior to discharge compared to GM and HH (1% vs 8.4% and 14.9% respectively, p< 0.001). (Table) Conclusion: This study demonstrates differences in baseline characteristics and outcomes for decompensated patients admitted to GM, MH, and HH services for management of decompensations. Overall, this study speaks to shorter hospitalizations and decreased incidence of death for patients presenting with decompensated cirrhosis on HH versus GM services, however, further investigations would be needed to determine the rationale for differing patient outcomes, as this was not reflected in ICU transfers. Table 1. - Comparison of reason for admission between hospitalist led service without a hepatology consult (GM), hospitalist led service with a hepatology consult (MH), and a hepatologist led service (HH) Reason for Admission GM MH HH P value Bleeding esophageal varices (EV) 32.5% 29.8% 37.6% 0.054 Hepatic Encephalopathy (HE) 30.4% 36.2% 33.4% 0.054 Spontaneous Bacterial Peritonitis (SBP) 29.5% 33.7% 36.8% 0.058 Ascites 25.8% 35.0% 39.2% 0.036 Hepatorenal Syndrome (HRS) 28.8% 34.4% 36.7% 0.000