The effect of hospital volume on patient outcomes in severe acute pancreatitis
The effect of hospital volume on patient outcomes in severe acute pancreatitis
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DOI：
10.1186/1471-230x-12-112
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发表时间：
2012-08-17
影响因子：
2.4
通讯作者：
Li, Chung-Yi
中科院分区：
文献类型：
--
作者：
Shen, Hsiu-Nien;Lu, Chin-Li;Li, Chung-Yi
背景：我们研究了重症急性胰腺炎（SAP）患者住院量与预后的关系。的决心是很重要的，因为病人的结果可能会得到改善，通过基于体积的选择性referreration.Methods：在这项队列研究中，我们分析了22,551 SAP患者在2,208年（2000年至2009年）从台湾的国民健康保险研究数据库。主要结局为住院死亡率。次要结果是住院时间和费用。医院SAP量作为分类变量和连续变量（每住院年增加一例）进行测量。使用多变量logistic回归模型和广义估计方程评估医院聚集效应。调整后的协变量包括患者和医院特征（模型1），以及其他治疗变量（模型2）。无论测量结果如何，在调整患者和医院特征后，增加医院容量与医院死亡风险降低相关（每增加一例病例的调整优势比[OR] 0.995，95%置信区间[CI] 0.993-0.998）。在调整患者和医院特征后，在最高容量四分位数（>= 14例/住院年）中接受治疗的患者的医院死亡风险比在最低容量四分位数（1例/住院年）中的患者低42%（调整OR 0.58，95%CI 0.40-0.83）。然而，只有当体积作为分类变量进行分析时，才观察到体积与住院时间或住院费用之间的负相关关系。调整后的治疗协变量，无论体积measures.Conclusions医院死亡率的体积效应消失：这些研究结果支持使用基于体积的选择性转诊SAP患者，并建议在医院之间的护理水平或过程的差异可能促成了体积效应。
Background: We investigated the relation between hospital volume and outcome in patients with severe acute pancreatitis (SAP). The determination is important because patient outcome may be improved through volume-based selective referral.Methods: In this cohort study, we analyzed 22,551 SAP patients in 2,208 hospital-years (between 2000 and 2009) from Taiwan's National Health Insurance Research Database. Primary outcome was hospital mortality. Secondary outcomes were hospital length of stay and charges. Hospital SAP volume was measured both as categorical and as continuous variables (per one case increase each hospital-year). The effect was assessed using multivariable logistic regression models with generalized estimating equations accounting for hospital clustering effect. Adjusted covariates included patient and hospital characteristics (model 1), and additional treatment variables (model 2).Results: Irrespective of the measurements, increasing hospital volume was associated with reduced risk of hospital mortality after adjusting the patient and hospital characteristics (adjusted odds ratio [OR] 0.995, 95% confidence interval [CI] 0.993-0.998 for per one case increase). The patients treated in the highest volume quartile (>= 14 cases per hospital-year) had 42% lower risk of hospital mortality than those in the lowest volume quartile (1 case per hospital-year) after adjusting the patient and hospital characteristics (adjusted OR 0.58, 95% CI 0.40-0.83). However, an inverse relation between volume and hospital stay or hospital charges was observed only when the volume was analyzed as a categorical variable. After adjusting the treatment covariates, the volume effect on hospital mortality disappeared regardless of the volume measures.Conclusions: These findings support the use of volume-based selective referral for patients with SAP and suggest that differences in levels or processes of care among hospitals may have contributed to the volume effect.