P0712 - Cannabinoid Use and Total Hospital Cost in Patients With Cirrhosis: A Study Based on Nationwide Inpatient

Rajesh Essrani, MD¹, Muhammad Usman Zafar, MD¹, Zahid I. Tarar, MD², Umer Farooq, MD³, Jiten Kothadia, MD^4
1Lehigh Valley Health Network, Allentown, PA; ²University of Missouri School of Medicine, Columbia, MO; ³Loyola Medicine/MacNeal Hospital, Berwyn, IL; ⁴University of Tennessee Health Science Center, Memphis, TN

Introduction: The cannabinoid is becoming legal in an increasing number of states in the USA for both medical and recreational use. However, substantial controversy still exists about the public health consequence of these changes. Conflicting evidence exists regarding the effect of cannabinoid use on patients with cirrhosis. We aim to evaluate the impact of cannabinoid use on the total hospital cost of patients admitted because of cirrhosis using Nationwide Inpatient Sample (NIS).

Methods: Nationwide inpatient sample (NIS) was analyzed from 2017 to 2018 for patients (age >18 years) with a primary diagnosis of liver cirrhosis (LC) (N= 410825) and a secondary diagnosis of cannabinoid use (N=12325) using disease-specific ICD-10 code. The total hospital charges were compared in LC patients with and without cannabinoid use. Multiple confounders like Charlson comorbidity index (CCI), coronary artery disease, opioid use, anxiety, depression, congestive heart failure, smoking, hyperlipidemia, alcohol intake, diabetes mellitus, myocardial infarction, chronic kidney disease, gender, age, race, hospital region, hospital teaching status, hospital bed size, and patient’s economic status were included to adjust for biases. The univariate and multivariate logistic regression analysis was used in STAT MP 16.1 to measure total hospital charges.

Results: Cannabinoid use was found in 3% (12,325) of total cirrhosis-related admissions (410825). The mean age of LC patients with cannabinoids use was 48 years old. There was a male predominance noticed in the cannabinoids use group (68%). Cannabinoids significantly lower total hospital charges $11566 (p = 0.000, 95% CI 15533-7599) independent of other confounders. Factors contributing to higher cost include higher Charlson comorbidity index (CCI), patients admitted to teaching hospitals, patients admitted to medium/large bed-sized hospitals, patients living in household income of >25th percentile, and patients admitted to the western region (Table 1).

Discussion: Cannabinoid use is associated with decreased total hospital cost of patients admitted because of cirrhosis. Future prospective studies are needed to conclude a clear therapeutic role of cannabinoids in patients with cirrhosis.

Table 1: Total Hospital Charge
Variable (Total Charge)	Coefficient	p-Value	95% Confidence Intervals
Cannabinoid	-11566.74	0.000	-15533.82	-7599.65
Charlson Index	4459.62	0.000	3730.31	5188.93
History of Coronary Artery Disease	-1336.87	0.364	-4221.18	1547.44
Opioid Use	-11191.19	0.000	-15607.09	-6775.29
anxiety	-2739.91	0.023	-5100.98	-378.84
Depression	-7260.91	0.000	-9590.07	-4931.76
History of Congestive Heart Failure	-2604.25	0.316	-7699.51	2491.01
Smoking	-7425.24	0.000	-10023.00	-4827.48
Hyperlipidemia	-7466.22	0.000	-9923.74	-5008.70
Alcohol Intake	-11684.26	0.000	-14464.71	-8903.82
Diabetes Mellitus	-16100.92	0.000	-18609.81	-13592.03
Myocardial Infarction	-18977.89	0.000	-22736.36	-15219.42
Chronic Kidney Disease	3537.26	0.074	-341.99	7416.50
Weekend Admission	-642.29	0.557	-2784.04	1499.46
Age	-546.20	0.000	-646.32	-446.08
Female	-1362.69	0.148	-3207.90	482.51
Race (compared to White)
Black	-176.48	0.920	-3599.82	3246.86
Hispanic	3088.78	0.056	-80.25	6257.82
Asian or Pacific Islander	15360.99	0.066	-1002.93	31724.91
Native American	-15795.36	0.000	-22410.39	-9180.33
Other	11588.64	0.001	4673.63	18503.66
Median Household Income for Patient's Zipcode (compared to 0-25th percentile)
26th-50th percentile	5408.85	0.000	2873.65	7944.05
51st-75th percentile	10432.49	0.000	7088.04	13776.95
76th-100th percentile	19257.31	0.000	14754.73	23759.89
Hospital Teaching Status	23968.23	0.000	20216.32	27720.14
Region of Hospital (compared to Northeast)
Midwest	-14253.32	0.000	-21560.49	-6946.15
South	-7183.77	0.029	-13617.48	-750.05
West	13067.98	0.008	3436.60	22699.36
Hospital Belsize (compared to small)
Medium	11838.69	0.000	8109.10	15568.27
Large	30021.97	0.000	25129.28	34914.65

Table: Table 1: Total Hospital Charge.


Disclosures:
Rajesh Essrani indicated no relevant financial relationships.
Muhammad Usman Zafar indicated no relevant financial relationships.
Zahid Tarar indicated no relevant financial relationships.
Umer Farooq indicated no relevant financial relationships.
Jiten Kothadia indicated no relevant financial relationships.


Rajesh Essrani, MD¹, Muhammad Usman Zafar, MD¹, Zahid I. Tarar, MD², Umer Farooq, MD³, Jiten Kothadia, MD⁴. P0712 - Cannabinoid Use and Total Hospital Cost in Patients With Cirrhosis: A Study Based on Nationwide Inpatient, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.