Format

Send to

Choose Destination
See comment in PubMed Commons below
Gastrointest Endosc. 2009 Sep;70(3):422-32. doi: 10.1016/j.gie.2008.12.061. Epub 2009 Jun 27.

Higher hospital volume is associated with lower mortality in acute nonvariceal upper-GI hemorrhage.

Author information

1
Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. aanantha@mcw.edu

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.

PMID:
19560760
DOI:
10.1016/j.gie.2008.12.061
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Support Center