Faculty Collaboration Database

Higher hospital volume is associated with lower mortality in acute nonvariceal upper-GI hemorrhage. Gastrointest Endosc 2009 Sep;70(3):422-32

Date

06/30/2009

Pubmed ID

19560760

DOI

10.1016/j.gie.2008.12.061

Scopus ID

2-s2.0-68949149759 (requires institutional sign-in at Scopus site)   22 Citations

Abstract

BACKGROUND: Acute nonvariceal upper-GI hemorrhage (NVUGIH) is associated with significant morbidity and mortality.

OBJECTIVE: To examine the relationship between hospital volume and outcomes of NVUGIH.

DESIGN: A cross-sectional study.

SETTING: Participating hospitals from the Nationwide Inpatient Sample 2004.

PATIENTS: All discharged patients with a primary discharge diagnosis of NVUGIH based on the International Classification of Diseases, Clinical Modification, ninth edition codes.

INTERVENTIONS: Patients were divided into 3 groups based on discharge from hospitals with annual discharge volumes of 1 to 125 (low), 126 to 250 (medium), and >250 (high).

MAIN OUTCOME MEASUREMENTS: In-hospital mortality, length of stay, and hospitalization charges.

RESULTS: The study included a total of 135,366, 132,746, and 123,007 discharges with NVUGIH occurred from low-volume, medium-volume, and high-volume hospitals, respectively. On multivariate analysis, when adjusting for age, comorbidity, and the presence of complications, patients at high-volume hospitals had significantly lower in-hospital mortality (odds ratio [OR] 0.85 [95% CI, 0.74-0.98]) than patients at low-volume hospitals. Patients at high-volume hospitals were also more likely to undergo upper-GI endoscopy (OR 1.52 [95% CI, 1.36-1.69]) or early endoscopy within 1 day of hospitalization compared with low-volume hospitals (60.5% vs 53.8%, adjusted OR 1.28 [95% CI, 1.02-1.61]). Undergoing endoscopy within day 1 was associated with shorter hospital stays (-1.08 days [95% CI, -1.24 to -0.92 days]) and lower hospitalization charges (-$1958 [95% CI, -$3227 to -$688]).

LIMITATIONS: The study was based on an administrative data set.

CONCLUSIONS: Higher hospital volume is associated with lower mortality and with higher rates of endoscopy and endoscopic intervention in patients with NVUGIH.

Author List

Ananthakrishnan AN, McGinley EL, Saeian K

Authors

Emily L. McGinley Biostatistician III in the Center for Advancing Population Science department at Medical College of Wisconsin
Kia Saeian MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Disease
Adolescent
Adult
Aged
Clinical Competence
Confidence Intervals
Emergency Treatment
Esophageal and Gastric Varices
Esophagoscopy
Female
Gastrointestinal Hemorrhage
Hemostasis, Endoscopic
Hospital Costs
Hospital Mortality
Hospitalization
Humans
Length of Stay
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Patient Discharge
Probability
Risk Assessment
Survival Analysis
Workload