Decreasing in-hospital mortality for oesophageal variceal hemorrhage in the USA.

BACKGROUND

To date, no study has analyzed nationwide trends of in-hospital mortality related to oesophageal variceal hemorrhage in the USA. The aim of this study was to analyze trends of in-hospital mortality related to oesophageal variceal bleeding over the past two decades using a large national database. In addition, our aim was to study patient demographics and to identify risk factors for in-hospital mortality based on administrative data routinely collected in this population.

METHODS

The nationwide inpatient sample database was used from 1988 to 2004. Patients with an International Classification of Diseases, ninth revision, Clinical Modification discharge diagnosis of oesophageal variceal bleeding were included. Patient demographics, hospital, and admission characteristics were collected. t-test and Poisson regression analysis were used to evaluate trends. Logistic regression analysis was performed to determine the relationship between mortality and patient/hospital characteristics.

RESULTS

From 1988 to 2004, crude in-hospital mortality decreased from 18 to 11.5%, whereas the age-adjusted in-hospital mortality rate decreased 45.4% from 1289 per 100,000 to 704 per 100,000 (P<0.01). Mortality was consistently higher for males and for African-Americans over the study period. For the 2001 dataset, multivariate logistic regression analysis showed that male sex, African-American race, age, large hospital size, urban location, teaching hospitals, and hospitals located in the northeast were independent risk factors for increased mortality.

CONCLUSION

The in-hospital mortality of patients with oesophageal variceal bleeding has decreased over the past two decades and is likely due to the advances made in the acute management of variceal bleeding as well as improved resuscitative methods. Male sex, African-American race, age, large hospital size, urban location, teaching hospitals, and hospitals located in the northeast are independent risk factors for increased in-hospital mortality.