Admission volume determines outcome for patients with acute pancreatitis
Authors
Singla, AnandSimons, Jessica P.
Li, Youfu
Csikesz, Nicholas G.
Ng, Sing Chau
Tseng, Jennifer F.
Shah, Shimul A.
UMass Chan Affiliations
Department of SurgeryDocument Type
Journal ArticlePublication Date
2009-09-08Keywords
Acute DiseaseCase-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
Metadata
Show full item recordAbstract
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.Source
Gastroenterology. 2009 Dec;137(6):1995-2001. Epub 2009 Sep 3. Link to article on publisher's siteDOI
10.1053/j.gastro.2009.08.056Permanent Link to this Item
http://hdl.handle.net/20.500.14038/49438PubMed ID
19733570Notes
Medical student Anand Singla participated in this study as part of his Senior Scholars research project.Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1053/j.gastro.2009.08.056