Ananthakrishnan Ashwin N, McGinley Emily L, Saeian Kia
Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Gastrointest Endosc. 2009 Feb;69(2):221-9. doi: 10.1016/j.gie.2008.04.065. Epub 2008 Oct 23.
Acute variceal hemorrhage (AVH) is an important complication of cirrhosis that carries a high mortality rate. Management of AVH requires early initiation of specialized care that may be more readily available at centers that deal with a high volume of AVH.
Our purpose was to examine the relationship between the annual hospitalization volume and the in-hospital mortality rate for AVH.
Cross-sectional study from a national representative sample.
A 20% sample of all nonfederal short-term hospitals from 37 states participating in the Nationwide Inpatient Sample 2004.
A total of 28,817 discharges with AVH identified through appropriate International Classification of Diseases, 9th Revision, Clinical Modification codes for bleeding esophageal varices. Hospitals were divided into low-, medium-, and high-volume hospitals if they had 1 to 15, 16 to 35, and 36 or more annual discharges related to AVH.
In-hospital mortality rate.
On multivariate analysis, there was no significant difference in the mortality rate either for medium- (odds ratio [OR] 0.84; 95% CI, 0.67-1.05) or high-volume hospitals (OR 1.06; 95% CI, 0.82-1.37). However, patients both at medium- (OR 1.27; 95% CI, 1.02-1.58) and high-volume hospitals (OR 1.40; 95% CI, 1.07-1.84) were more likely to undergo endoscopy for AVH. Endoscopic intervention for control of variceal hemorrhage was significantly more common in medium- (OR 1.20) and high- (OR 1.33) volume hospitals. Patients at medium- (OR 3.10; 95% CI, 2.09-4.60) and high-volume hospitals (OR 4.12; 95% CI, 2.52-6.75) were also more likely to undergo transjugular intrahepatic portosystemic shunt (TIPS).
Higher hospital volume is associated with greater rates of endoscopy, endoscopic intervention, and higher utilization of TIPS in the management of AVH.
急性静脉曲张出血（AVH）是肝硬化的一种重要并发症，死亡率很高。AVH的管理需要尽早开始专科护理，而在处理大量AVH病例的中心可能更容易获得这种护理。
我们的目的是研究AVH的年住院量与住院死亡率之间的关系。
来自全国代表性样本的横断面研究。
从参与2004年全国住院患者样本的37个州的所有非联邦短期医院中抽取20%的样本。
通过适当的国际疾病分类第九版临床修订版代码确定的28817例伴有食管静脉曲张出血的AVH出院病例。如果医院每年有1至15例、16至35例以及36例或更多与AVH相关的出院病例，则分为低、中、高住院量医院。
住院死亡率。
多因素分析显示，中住院量医院（比值比[OR]0.84；95%可信区间[CI]，0.67 - 1.05）和高住院量医院（OR 1.06；95%CI，0.82 - 1.37）的死亡率均无显著差异。然而，中住院量医院（OR 1.27；95%CI，1.02 - 1.58）和高住院量医院（OR 1.40；95%CI，1.07 - 1.84）的患者接受AVH内镜检查的可能性更高。在中住院量医院（OR 1.20）和高住院量医院（OR 1.33），内镜干预控制静脉曲张出血明显更为常见。中住院量医院（OR 3.10；95%CI，2.09 - 4.60）和高住院量医院（OR 4.12；95%CI，2.52 - 6.75）的患者接受经颈静脉肝内门体分流术（TIPS）的可能性也更高。
在AVH的管理中，较高的医院住院量与更高的内镜检查率、内镜干预率以及TIPS的更高利用率相关。
