Ananthakrishnan Ashwin N, McGinley Emily L, Saeian Kia
Department of Population Health, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Liver Transpl. 2008 Sep;14(9):1347-56. doi: 10.1002/lt.21519.
Acute liver failure (ALF) often requires multidisciplinary support. Higher hospital volumes have been associated with better outcomes for surgical procedures, but whether such a relationship exists for ALF has not been explored previously. In this study, our aim was to examine if hospital volume affects mortality from ALF. Using data from the Nationwide Inpatient Sample for the years 2001 to 2004, we identified cases by the presence of a primary discharge diagnosis of ALF (International Classification of Diseases, 9th revision, Clinical Modification code 570.x). Hospitals were divided into low-, medium-, and high-volume hospitals on the basis of 1 to 5, 6 to 20, and more than 20 annual ALF discharges. There were 17,361, 6756, and 1790 discharges with ALF from low-, medium-, and high-volume hospitals, respectively. There was no difference in adjusted mortality between low- and high-volume hospitals (odds ratio 0.94, 95% confidence interval 0.68-1.28). Teaching hospitals had a trend toward lower mortality among patients with hepatic encephalopathy (odds ratio 0.69, 95% confidence interval 0.47-1.01). High-volume centers had a higher rate of orthotopic liver transplantation (OLT) primarily because they were transplant centers, had better in-hospital post-OLT survival, and showed a trend toward a shorter time to OLT. In conclusion, patients with ALF receiving care at teaching hospitals and high-volume centers tend to be sicker. However, teaching hospitals and high-volume centers have equivalent in-hospital survival despite caring for this more severely ill cohort.
急性肝衰竭（ALF）通常需要多学科支持。较高的医院接诊量与外科手术更好的预后相关，但此前尚未探讨过这种关系是否也存在于ALF。在本研究中，我们的目的是检验医院接诊量是否会影响ALF患者的死亡率。利用2001年至2004年全国住院患者样本的数据，我们通过主要出院诊断为ALF（国际疾病分类第九版临床修订本代码570.x）来确定病例。根据每年1至5例、6至20例以及超过20例的ALF出院病例数，将医院分为低接诊量、中等接诊量和高接诊量医院。低接诊量、中等接诊量和高接诊量医院分别有17361例、6756例和1790例ALF出院病例。低接诊量和高接诊量医院之间的校正死亡率没有差异（比值比0.94，95%置信区间0.68 - 1.28）。教学医院中肝性脑病患者的死亡率有降低趋势（比值比0.69，95%置信区间0.47 - 1.01）。高接诊量中心原位肝移植（OLT）的比例较高，主要是因为它们是移植中心，OLT术后院内生存率更高，且OLT时间有缩短趋势。总之，在教学医院和高接诊量中心接受治疗的ALF患者往往病情更重。然而，尽管照料的是病情更严重的这一队列患者，教学医院和高接诊量中心的院内生存率相当。
