COVID‐19‐related downscaling of in‐hospital liver care decreased patient satisfaction and increased liver‐related mortality

Hartl, Lukas; Semmler, Georg; Hofer, Benedikt Silvester; Schirwani, Nawa; Jachs, Mathias; Simbrunner, Benedikt; Bauer, David Josef Maria; Binter, Teresa; Pomej, Katharina; Pinter, Matthias; Trauner, Michael; Mandorfer, Mattias; Reiberger, Thomas; Scheiner, Bernhard

BACKGROUND&AIMS: The COVID‐19 pandemic necessitated down‐scaling of in‐hospital care to prohibit the spread of severe acute respiratory syndrome‐coronavirus‐2(SARS‐CoV‐2). We (i)assessed patient perceptions on quality of care by tele‐survey(cohort 1) and written questionnaire(cohort 2) and (ii)analyzed trends in elective and non‐elective admissions prior to (12/2019‐02/2020) and during (03/2020‐05/2020) the COVID‐19 pandemic in Austria. METHODS: Two‐hundred seventy‐nine outpatients were recruited into cohort 1 and 138 patients into cohort 2. All admissions from 12/2019 to 05/2020 to the Division of Gastroenterology/Hepatology at the Vienna General Hospital were analyzed. RESULTS: Thirty‐two point six percent (n=91/279) of cohort 1 and 72.5%(n=95/131) of cohort 2 had tele‐medical contact, while 59.5%(n=166/279)and 68.2%(n=90/132) had face‐to‐face visits. 24.1%(n=32/133) needed acute medical help during healthcare restrictions, however, 57.3%(n=51/89) reported that contacting their physician during COVID‐19 was difficult or impossible. Patient‐reported satisfaction with treatment decreased significantly during restrictions in cohort 1 (visual analog scale[VAS] 0‐10:9.0±1.6 to8.6±2.2;p<0.001) and non‐significantly in cohort 2 (VAS0‐10:8.9±1.6 to8.7±2.1;p=0.182). Despite fewer hospital admissions during COVID‐19, the proportion of non‐elective admissions (+6.3%) and ICU‐admissions (+6.7%) increased. Cirrhotic patients with non‐elective admissions during COVID‐19 had significantly higher MELD (25.5[14.2]vs.17.0[IQR:8.8]; p=0.003) and ΔMELD(difference to last MELD;3.9±6.3vs.8.7±6.4;p=0.008), required immediate intensive care more frequently (26.7%vs.5.6%;p=0.034) and had significantly increased 30‐day liver‐related mortality (30.0%vs.8.3%;p=0.028). CONCLUSIONS: The COVID‐19 pandemic impacts on quality of liver care as evident from decreased patient satisfaction, hospitalization of sicker ACLD patients and increased liver‐related mortality. Strategies for improved tele‐medical liver care and preemptive treatment of cirrhosis‐related complications are needed to counteract the COVID‐19‐associated restrictions of in‐hospital care.