# Hospitalization Trends Due to Chronic Liver Diseases: Vicious Circle of Co-Morbidities and Hospitalization Length

## TL;DR

This study examines how co-morbidities and cirrhosis affect hospitalization length for chronic liver diseases in Serbia, finding that early detection and better management could reduce healthcare costs.

## Contribution

The study introduces a Bayesian modeling approach to estimate the direct causal effect of diagnosis type on hospitalization length for chronic liver diseases.

## Key findings

- Average hospitalization length decreased from 8.25 to 5.51 days between 2016 and 2022.
- Autoimmune liver disease had the highest expected length of stay at 15.89 days.
- Cirrhosis had the largest impact on hospitalization length for viral liver disease patients.

## Abstract

Background and Aims: Chronic liver diseases (CLD) represent a significant healthcare burden, mostly due to late diagnosis and numerous co-morbidities. We evaluated the effect of co-morbidities, cirrhosis, and disease etiology on hospitalization duration. Methods: Hospitalizations due to alcohol-related, viral, autoimmune, and overlapping liver disease in Belgrade, Serbia (2016–2022), were identified using pre-defined discharge codes. We investigated the hospitalization trend descriptively by plotting the relative mean change in the hospitalization length against time. Assuming the covariate relationship in the directed acyclic graph, we estimated the direct causal effect of the diagnosis type on the length of stay (LOS) by fitting pre-specified Bayesian distributional lognormal models based on domain knowledge. We conducted a post hoc analysis of the impact of cirrhosis on LOS per primary diagnosis. Results: The empirical data show a decrease in the estimated average LOS (8.25–5.51 days). For the same period, the median LOS decreased (4 days (IQR 0–12) to 1 day (IQR 1–7)). In 2021, the share of short-term hospitalizations rose to 46.94%, while the median long-term hospitalization peaked at 11.5 days (IQR 7–21). The expected LOS was the highest for the primary diagnosis of autoimmune liver disease (15.89, 95% CI [14.74, 17.2] days), followed by alcohol-related liver disease (14.22, 95% CI [13.68, 14.79] days). The largest impact of cirrhosis on LOS was observed among patients hospitalized due to viral disease (4.19, 95% CI [2.29, 6.33] days). Conclusions: The presence of co-morbidities and cirrhosis significantly affects LOS. In order to provide better treatment and reduce healthcare costs, there is the need to detect liver disease at earlier stages and better manage its associated co-morbidities.