Failure-to-rescue following acute hepatic decompensation in hospitalized patients with hepatocellular carcinoma in the United States, 2018–2022.

Abstract

e23119 Background: In hospitalized oncology populations, mortality may be influenced by failure to rescue after acute deterioration. Hepatocellular carcinoma (HCC) is frequently complicated by hepatic decompensation, yet national data describing failure-to-rescue patterns in this population remain limited. Methods: A serial cross-sectional analysis was conducted using the 2018–2022 Healthcare Cost and Utilization Project National Inpatient Sample. Adult hospitalizations with a principal diagnosis of hepatocellular carcinoma were identified. Acute hepatic decompensation was defined using secondary diagnosis codes for ascites, variceal bleeding, hepatic encephalopathy, hepatorenal syndrome, or spontaneous bacterial peritonitis. Failure-to-rescue was defined as in-hospital mortality among hospitalizations with hepatic decompensation. Outcomes included in-hospital mortality, length of stay (LOS), and hospitalization cost estimated using cost-charge ratios. National estimates accounted for survey weighting, clustering, and stratification. Stratified analyses evaluated outcomes by hospital teaching status, bed size, region, and patient urban–rural residence. Survey-weighted multivariable logistic regression, restricted to decompensated hospitalizations, identified factors independently associated with in-hospital mortality. Results: From 2018–2022, 22,531 unweighted HCC hospitalizations represented an estimated 112,655 hospitalizations nationally. Acute hepatic decompensation occurred in 41.1% of hospitalizations. Overall in-hospital mortality was 7.6%, increasing to 12.8% among hospitalizations complicated by hepatic decompensation, compared with 1.4% among non-decompensated admissions. Decompensated hospitalizations were associated with longer LOS (7.51 vs 5.66 days) and higher costs ($31,941 vs $25,644). Failure-to-rescue varied across hospital settings, with lower mortality at teaching and large hospitals despite similar decompensation incidence. In adjusted analyses restricted to decompensated hospitalizations, admission to a teaching hospital was associated with lower odds of mortality (adjusted odds ratio 0.39, 95% CI 0.26–0.59). Increasing age, non-private insurance, and Black race were independently associated with higher mortality, while hospital bed size and region remained significant. Conclusions: Among HCC hospitalizations, hepatic decompensation was common and associated with higher inpatient mortality, longer length of stay, and higher costs. Although decompensation incidence was similar across settings, failure-to-rescue varied by hospital characteristics and region. These findings provide benchmarking data for rescue outcomes following acute hepatic decompensation in hospitalized patients with HCC.