Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, 55 Lake Avenue North, S6-432, Worcester, MA 01655, USA.
J Gastrointest Surg. 2011 Feb;15(2):330-5. doi: 10.1007/s11605-010-1398-1. Epub 2010 Nov 25.
Close to 30,000 people die of cirrhosis in the USA each year. Previous studies have shown a survival advantage with high-volume (HV) hospitals for complex surgical procedures. We examined whether a volume benefit exists for hospitals dealing with specialized disorders like complications of cirrhosis.
Using the Nationwide Inpatient Sample, we identified all cases of cirrhosis-related complications (n = 217,948) from 1998 to 2006. Hospital volume was divided into tertile-based admissions for cirrhosis per year.
The primary outcome was in-hospital mortality, and secondary endpoints included length of stay (LOS) and hospital charges. The number of admissions for cirrhosis increased over time (p < 0.0001). HV centers were more likely to be large (86.8%) and teaching (81.5%) hospitals compared to lower volume centers. The average LOS and hospital charges were greater at the HV centers, but hospitalization at a HV center resulted in an adjusted mortality benefit (HR 0.88; 95% CI 0.83-0.92) compared to care at lower volume hospitals.
Despite increased LOS and hospital cost, a mortality benefit exists at HV centers. Future studies are necessary to determine other processes of care that may exist at HV centers that may account for this survival benefit.
每年在美国，约有 3 万人死于肝硬化。既往研究表明，在处理复杂手术时，高容量（HV）医院具有生存优势。我们研究了专门处理肝硬化等特殊疾病并发症的医院是否存在容量优势。
使用全国住院患者样本，我们从 1998 年至 2006 年确定了所有与肝硬化相关并发症的病例（n=217948）。根据每年肝硬化的入院人数，将医院容量分为三分位。
主要结果是院内死亡率，次要终点包括住院时间（LOS）和住院费用。肝硬化的入院人数随时间增加（p<0.0001）。与低容量中心相比，HV 中心更有可能是大型（86.8%）和教学（81.5%）医院。HV 中心的平均 LOS 和住院费用更高，但与低容量医院相比，HV 中心的住院治疗可降低死亡率（HR 0.88；95%CI 0.83-0.92）。
尽管 LOS 和住院费用增加，但 HV 中心仍存在死亡率优势。需要进一步研究以确定 HV 中心可能存在的其他护理流程，这些流程可能是这种生存优势的原因。
