Presentation (CTI)

OBJECTIVES: Cirrhosis is the main cause of portal hypertension (PH), leading to ascites and/or variceal bleeding that significantly impacts patient survival. The main objectives of the study were to describe the hospital management of PH using large volume paracentesis (LVP) and endoscopic band ligation (EBL) and estimate their burden.
METHODS: This retrospective population-based cohort study was performed using the French exhaustive national hospital discharge database (PMSI). Patients were included if they had at least 3 hospital stays for LVP and/or 2 hospital stays for EBL in one year between January 1, 2018 and December 31, 2020, by combining diagnosis and procedure classification codes (ICD-10 and CCAM). Each patient was followed-up for up to three years after cohort entry date and recurrence of hospitalizations for LVP or EBL were retrieved and analyzed.
RESULTS: Between 2018 and 2020, 19,833 patients were hospitalized for ascites and/or variceal bleeding: 11,900 with ascites alone (mean 37,000 LVP stays/year), 6,923 with variceal bleeding (mean 7,200 EBL stays/year), and 1,010 with both. Mean length of stay (LOS) was 5.4 ± 8.7 days. Overall survival was 63.1% at one year and 47.8% at two years. Among 12,910 patients presenting with ascites, 9,282 (71.9%) were rehospitalized for LVP within an average of 28 days; of the 7,933 presenting with bleeding, 4,244 (53.5%) were rehospitalized for EBL within an average of 92 days. Total annual costs associated with LVP and EBL stays were estimated at approx. €207 million, corresponding to 50,000 hospital stays.
CONCLUSIONS: This study confirms the high burden of PH complications in France due to the high rate of ascites recurrence and treatments for bleeding. Given the anticipated increase in cirrhosis, it highlights the need to offer more patients dedicated proven solutions commensurate with international guidelines to achieve the desired survival rates.