Admission volume determines outcome for patients with acute pancreatitis
Department of Surgery
Medical Subject Headings
Acute Disease; Case-Control Studies; Comorbidity; Female; Health Services Research; Hospital Costs; Hospital Mortality; Hospitals; Humans; Length of Stay; Logistic Models; Male; Middle Aged; Odds Ratio; Outcome and Process Assessment (Health Care); Pancreatitis; Patient Admission; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; United States
Life Sciences | Medicine and Health Sciences
BACKGROUND and AIMS: There is controversy over the optimal management strategy for patients with acute pancreatitis (AP). Studies have shown a hospital volume benefit for in-hospital mortality after surgery, and we examined whether a similar mortality benefit exists for patients admitted with AP. METHODS: Using the Nationwide Inpatient Sample, discharge records for all adult admissions with a primary diagnosis of AP (n = 416,489) from 1998 to 2006 were examined. Hospitals were categorized based on number of patients with AP; the highest third were defined as high volume (HV, >or=118 cases/year) and the lower two thirds as low volume (LV, <118 cases>/year). A matched cohort based on propensity scores (n = 43,108 in each group) eliminated all demographic differences to create a case-controlled analysis. Adjusted mortality was the primary outcome measure.
RESULTS: In-hospital mortality for patients with AP was 1.6%. Hospital admissions for AP increased over the study period (P < .0001). HV hospitals tended to be large (82%), urban (99%), academic centers (59%) that cared for patients with greater comorbidities (P < .001). Adjusted length of stay was lower at HV compared with LV hospitals (odds ratio, 0.86; 95% confidence interval, 0.82-0.90). After adjusting for patient and hospital factors, the mortality rate was significantly lower for patients treated at HV hospitals (hazard ratio, 0.74; 95% confidence interval, 0.67-0.83).
CONCLUSIONS: The rates of admissions for AP in the United States are increasing. At hospitals that admit the most patients with AP, patients had a shorter length of stay, lower hospital charges, and lower mortality rates than controls in this matched analysis.
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Citation: Gastroenterology. 2009 Dec;137(6):1995-2001. Epub 2009 Sep 3. Link to article on publisher's site
Singla, Anand; Simons, Jessica P.; Li, Youfu; Csikesz, Nicholas G.; Ng, Sing Chau; Tseng, Jennifer F.; and Shah, Shimul A., "Admission volume determines outcome for patients with acute pancreatitis" (2009). University of Massachusetts Medical School. Senior Scholars Program. Paper 94.