The impact of a care pathway with systematical screening for cardiopulmonary complications, frailty, malnutrition and minimal hepatic encephalopathy in cirrhosis on patient care and hospital financing.
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Abstract
Background and aim of the study: Cardiopulmonary complications, malnutrition, frailty and minimal hepatic encephalopathy are underrecognized complications of cirrhosis with a major impact on mortality and morbidity. The aim of this study is to investigate a new locally introduced care pathway with standardized screening for these complications and its impact on patients care and hospital financing.
Patients and methods: We performed a single center retrospective study of 40 patients hospitalized with cirrhosis who participated in the care pathway between April 2023 and June 2024. Electronic medical records were evaluated for screened complications and financial outcomes were calculated within our population, consecutively with and without this care pathway. Long term data regarding survival and referral were collected in June 2025.
Results: Hepatopulmonary syndrome was diagnosed in 14.7% of the patients. Frailty was present in 57.7% of the patients and malnutrition in 45%. Minimal hepatic encephalopathy was established in 17.5% of the patients. The median justified hospital days were significantly higher with the care pathway compared to without [8.4 (6.0-10.8) vs 6.2( 4.9-8.6) p<0.01 ( Z=-3.43)]. In 15 (37.5%) patients, the care pathway added a higher financial reimbursement for the hospital compared to when the care pathway would not have been performed.
Conclusions: This study emphasizes the importance of systematic screening and education of these complications. Due to systematical screening these underrecognized complications get identified earlier. Performing this care pathway did significantly and positively impact the number of justified hospital days and financial reimbursement for the hospital.
期刊介绍：
The Journal Acta Gastro-Enterologica Belgica principally publishes peer-reviewed original manuscripts, reviews, letters to editors, book reviews and guidelines in the field of clinical Gastroenterology and Hepatology, including digestive oncology, digestive pathology, as well as nutrition. Pure animal or in vitro work will not be considered for publication in the Journal. Translational research papers (including sections of animal or in vitro work) are considered by the Journal if they have a clear relationship to or relevance for clinical hepato-gastroenterology (screening, disease mechanisms and/or new therapies). Case reports and clinical images will be accepted if they represent an important contribution to the description, the pathogenesis or the treatment of a specific gastroenterology or liver problem. The language of the Journal is English. Papers from any country will be considered for publication. Manuscripts submitted to the Journal should not have been published previously (in English or any other language), nor should they be under consideration for publication elsewhere. Unsolicited papers are peer-reviewed before it is decided whether they should be accepted, rejected, or returned for revision. Manuscripts that do not meet the presentation criteria (as indicated below) will be returned to the authors. Papers that go too far beyond the scope of the journal will be also returned to the authors by the editorial board generally within 2 weeks. The Journal reserves the right to edit the language of papers accepted for publication for clarity and correctness, and to make formal changes to ensure compliance with AGEB’s style. Authors have the opportunity to review such changes in the proofs.
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