Cirrhosis outcomes on rurality and weekend admissions revisited: A contemporary analysis of the national inpatient sample

Ahamed Khalyfa; Betty H Tu; Qianyi Shi; Tomohiro Tanaka

doi:10.1371/journal.pone.0353178

Back

Cirrhosis outcomes on rurality and weekend admissions revisited: A contemporary analysis of the national inpatient sample

Journal article

Open access

Peer reviewed

Cirrhosis outcomes on rurality and weekend admissions revisited: A contemporary analysis of the national inpatient sample

Ahamed Khalyfa, Betty H Tu, Qianyi Shi and Tomohiro Tanaka

PloS one, Vol.21(7), e0353178

07/01/2026

DOI: 10.1371/journal.pone.0353178

PMID: 42391252

Files and links (1)

url

https://doi.org/10.1371/journal.pone.0353178View

Published (Version of record) Open Access

Abstract

The impact of hospital rurality and weekend admission on outcomes in decompensated cirrhosis remains unclear. Studies suggest mixed effects of weekend admission on mortality and increased mortality in rural hospital admissions for decompensated cirrhosis. This study evaluated the influence of hospital rurality, weekend admission, and their interaction on outcomes in decompensated cirrhosis from 2016 to 2020. A cross-sectional analysis of the National Inpatient Sample (NIS) assessed in-hospital mortality (primary outcome), likelihood of specific procedures (esophagogastroduodenoscopy, paracentesis, TIPS, hemodialysis), and time to first procedure. Regression models adjusted for demographics, liver disease etiology, clinical severity (APR-DRG mortality risk), and other factors. Among 11,845,223 hospitalizations, rural hospitalizations were linked to lower in-hospital mortality (OR: 0.84; 95% CI: 0.80-0.86) and higher transfer rates for severe cases (7.2% vs. 2.8%, p < 0.001). Weekend admissions showed a statistically significant but only modest reduction in mortality odds (OR: 0.99; 95% CI: 0.975-0.998). No significant interaction existed between rurality and weekend admission regarding mortality. Rural hospitals showed lower odds of performing procedures (95% CIs < 1), though time to procedure was comparable, except for earlier hemodialysis (-1.35 days; 95% CI: -2.59 to -0.11). Weekend admissions did not significantly impact procedure rates, except for paracentesis (OR: 0.94; 95% CI: 0.88-0.99). Using a national cohort of hospitalized patients with decompensated cirrhosis, we showed that rural hospitals exhibited lower in-hospital mortality, fewer procedures, and higher transfer rates, and that weekend admissions showed only a minimal, clinically insignificant reduction in mortality, irrespective of hospital rurality.

Aged

Cross-Sectional Studies

Female

Hospital Mortality

Hospitalization - statistics & numerical data

Hospitals, Rural - statistics & numerical data

Humans

Inpatients - statistics & numerical data

Liver Cirrhosis - mortality

Liver Cirrhosis - therapy

Male

Middle Aged

Patient Admission - statistics & numerical data

Time Factors

United States - epidemiology

Details

Title: Subtitle: Cirrhosis outcomes on rurality and weekend admissions revisited: A contemporary analysis of the national inpatient sample
Creators: Ahamed Khalyfa - University of Iowa
Betty H Tu - University of Iowa
Qianyi Shi - University of Iowa
Tomohiro Tanaka - University of Iowa
Resource Type: Journal article
Publication Details: PloS one, Vol.21(7), e0353178
DOI: 10.1371/journal.pone.0353178
PMID: 42391252
NLM abbreviation: PLoS One
ISSN: 1932-6203
eISSN: 1932-6203
Publisher: PLoS
Grant note: Bruce L. Miller & M. Joyce Miller Memorial & Visiting Professorship
This study was funded by the divisional fund at the University of Iowa Division of Gastroenterology and Hepatology (the Bruce L. Miller & M. Joyce Miller Memorial & Visiting Professorship). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Language: English
Date published: 07/01/2026
Academic Unit: Health Management and Policy; Gastroenterology and Hepatology; Internal Medicine
Record Identifier: 9985179684802771

Metrics

1 Record Views