Singla Anand, Simons Jessica, Li YouFu, Csikesz Nicholas G, Ng Sing Chau, Tseng Jennifer F, Shah Shimul A
Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
Gastroenterology. 2009 Dec;137(6):1995-2001. doi: 10.1053/j.gastro.2009.08.056. Epub 2009 Sep 3.
BACKGROUND & 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.
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.
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).
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.
急性胰腺炎（AP）患者的最佳管理策略存在争议。研究表明，手术治疗后，医院规模对住院死亡率具有益处，我们探究了AP住院患者是否也存在类似的死亡率益处。
利用全国住院患者样本，研究1998年至2006年所有以AP为主要诊断的成人住院患者（n = 416,489）的出院记录。根据AP患者数量对医院进行分类；患者数量最多的三分之一被定义为高容量医院（HV，≥118例/年），较低的三分之二为低容量医院（LV，<118例/年）。基于倾向评分的匹配队列（每组n = 43,108）消除了所有人口统计学差异，以进行病例对照分析。调整后的死亡率是主要结局指标。
AP患者的住院死亡率为1.6%。在研究期间，AP的住院人数有所增加（P <.0001）。HV医院往往规模较大（82%）、位于城市（99%）、是学术中心（59%），且照料合并症更多的患者（P <.001）。与LV医院相比，HV医院调整后的住院时间更短（优势比，0.86；95%置信区间，0.82 - 0.90）。在调整患者和医院因素后，HV医院治疗的患者死亡率显著更低（风险比，0.74；95%置信区间，0.67 - 0.83）。
美国AP的住院率正在上升。在收治AP患者最多的医院，在这项匹配分析中，患者的住院时间更短、住院费用更低、死亡率也低于对照组。
