美国 1993 年至 2006 年消化性溃疡住院治疗的趋势和结果。

Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006.

机构信息

Department of Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA.

出版信息

Ann Surg. 2010 Jan;251(1):51-8. doi: 10.1097/SLA.0b013e3181b975b8.

DOI:10.1097/SLA.0b013e3181b975b8

PMID:20009753

Abstract

OBJECTIVES

Despite progress in diagnosis and treatment, peptic ulcer disease (PUD) remains a common reason for hospitalization and operation. The purpose of this study was to quantify the time trends of hospitalizations and operations for PUD in the United States (US) since 1993.

DATA AND METHODS

The Healthcare Cost and Utilization Project Nationwide Inpatient Sample is a 20% stratified sample of all hospitalizations in the United States. It was used to study hospitalizations with PUD as the principal diagnosis during 1993 to 2006, including details on ulcer site, complications, procedures, and mortality. Statistical methods included the chi test and multivariate logistic regression.

RESULTS

The national estimate of hospitalizations for PUD decreased significantly from 222,601 in 1993 to 156,108 in 2006 (-29.9%), with a larger reduction in duodenal ulcers (95,552 in 1993 vs. 60,029 in 2006, -37.2%) than gastric ulcers (106,987 in 1993 vs. 86,064 in 2006, -19.6%). The inpatient mortality rate of PUD decreased from 3.8% to 2.7% during 1993 to 2006 (P < 0.001). Hemorrhage remained the most common complication (71.6% in 1993; 73.3% in 2006) but perforation had the highest mortality (15.1% in 1993; 10.6% in 2006). In comparison to 1993, patients hospitalized for PUD in 2006 more frequently had endoscopic treatment to control bleeding (12.9% vs. 22.2%, P < 0.001), similar use of surgical oversewing of ulcer (7.6% vs. 7.4%), less use of gastrectomy (4.4% vs. 2.1%, P < 0.001), and less use of vagotomy (5.7% vs. 1.7%, P < 0.001). In multivariate logistic regressions, the determinants of mortality were similar in 1993 and 2006.

CONCLUSIONS

Hospitalizations for PUD decreased in the United States from 1993 to 2006, suggesting a decrease in the prevalence and/or severity of ulcer complications over this recent time period. Despite increased patient age and comorbidities, there has been a significant decrease in PUD mortality, a significant increase in the use of therapeutic endoscopy for bleeding ulcer, and a significant decrease in the use of definitive surgery (vagotomy or resection) for ulcer complications.

摘要

目的

尽管在诊断和治疗方面取得了进展，但消化性溃疡疾病（PUD）仍然是住院和手术的常见原因。本研究的目的是量化自 1993 年以来美国（US）因 PUD 住院和手术的时间趋势。

数据和方法

医疗保健成本和利用项目全国住院患者样本是美国所有住院患者的 20%分层样本。它被用于研究 1993 年至 2006 年期间 PUD 作为主要诊断的住院治疗情况，包括溃疡部位、并发症、程序和死亡率的详细信息。统计方法包括卡方检验和多变量逻辑回归。

结果

1993 年至 2006 年期间，PUD 住院治疗的全国估计值从 222601 例显著下降至 156108 例（下降 29.9%），十二指肠溃疡（1993 年为 95552 例，2006 年为 60029 例，下降 37.2%）的降幅大于胃溃疡（1993 年为 106987 例，2006 年为 86064 例，下降 19.6%）。1993 年至 2006 年期间，PUD 的住院死亡率从 3.8%下降至 2.7%（P<0.001）。出血仍然是最常见的并发症（1993 年为 71.6%；2006 年为 73.3%），但穿孔的死亡率最高（1993 年为 15.1%；2006 年为 10.6%）。与 1993 年相比，2006 年因 PUD 住院的患者更频繁地接受内镜治疗以控制出血（12.9%比 22.2%，P<0.001），类似地使用内镜缝合溃疡（7.6%比 7.4%），更少使用胃切除术（4.4%比 2.1%，P<0.001），更少使用迷走神经切断术（5.7%比 1.7%，P<0.001）。在多变量逻辑回归中，1993 年和 2006 年的死亡率决定因素相似。