COVID-19-Related Downscaling of In-Hospital Liver Care Decreased Patient Satisfaction and Increased Liver-Related Mortality

Abstract

The coronavirus disease 2019 (COVID-19) pandemic necessitated down-scaling of in-hospital care to prohibit the spread of severe acute respiratory syndrome-coronavirus-2. We (1) assessed patient perceptions on quality of care by telesurvey (cohort 1) and written questionnaire (cohort 2), and (2) analyzed trends in elective and nonelective admissions before (December 2019 to February 2020) and during (March to May 2020) the COVID-19 pandemic in Austria. A total of 279 outpatients were recruited into cohort 1 and 138 patients into cohort 2. All admissions from December 2019 to May 2020 to the Division of Gastroenterology/Hepatology at the Vienna General Hospital were analyzed. A total of 32.6% (n = 91 of 279) of cohort 1 and 72.5% (n = 95 of 131) of cohort 2 had telemedical contact, whereas 59.5% (n = 166 of 279) and 68.2% (n = 90 of 132) had face-to-face visits. A total of 24.1% (n = 32 of 133) needed acute medical help during health care restrictions; however, 57.3% (n = 51 of 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 to 8.6 ± 2.2; P < 0.001) and insignificantly in cohort 2 (VAS 0-10: 8.9 ± 1.6 to 8.7 ± 2.1; P = 0.182). Despite fewer hospital admissions during COVID-19, the proportion of nonelective admissions (+6.3%) and intensive care unit admissions (+6.7%) increased. Patients with cirrhosis with nonelective admissions during COVID-19 had significantly higher Model for End-Stage Liver Disease (MELD) (25.5 [14.2] vs. 17.0 [interquartile range: 8.8]; P = 0.003) and ΔMELD (difference from last MELD: 3.9 ± 6.3 vs. 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). Conclusion: The COVID-19 pandemic's effects on quality of liver care is evident from decreased patient satisfaction, hospitalization of sicker patients with advanced chronic liver disease, and increased liver-related mortality. Strategies for improved telemedical liver care and preemptive treatment of cirrhosis-related complications are needed to counteract the COVID-19-associated restrictions of in-hospital care.

FIG. 1

Patient flowchart. (A) Patients with ACLD or with a history of LT with regular visits at the hepatology outpatient clinic of the Vienna General Hospital were contacted for a telesurvey. Of the 418 contacted patients, n = 125 patients did not respond to the call. Most of the patients with ACLD (98.0%) and LT patients (100%) agreed to complete the survey, but n = 5 surveys were not fully completed, resulting in a final number of n = 274 patients (59.8%) completing the telesurvey. (B) Among patients who had a face‐to‐face visit at the Gastroenterology/Hepatology inpatient ward or outpatient clinic, n = 44 with nonadvanced chronic liver disease (including patients with viral hepatitis, cholestatic liver diseases, genetic and metabolic liver diseases), n = 85 with ACLD, and n = 9 patients in care after LT completed the written survey.

FIG. 2

Patient perception on quality of care before and during COVID‐19‐related restrictions of health care assessed through VAS (0‐10) by telesurvey (A) and written questionnaire (B). For analyses, patients were stratified to the following VAS categories: 0‐4, 5‐7, and 8‐10.

FIG. 3

Patient admissions. Number of patient admissions with liver disease to the Division of Gastroenterology and Hepatology at the Vienna General Hospital between December 2019 and May 2020. Elective and nonelective admissions before and during COVID‐19‐related health care restrictions are shown separately.

FIG. 4

Severity of liver disease as well as outcomes of patients with ACLD nonelectively admitted to the Vienna General Hospital before and during COVID‐19‐related health care restrictions. Comparison of MELD score (A), CLIF‐C AD score (B), ΔMELD (C), and ΔCLIF‐C AD (D) of nonelectively admitted patients with ACLD before and during COVID‐19‐related health care restrictions. Comparison of rates of nonelective admissions of patients with ACLD to the regular ward versus ICU (E) and liver‐related 30‐day mortality of patients with ACLD before and during COVID‐19‐related health care restrictions (F).