Mount Sinai Hospital, 445-600 University Avenue, Toronto, ON M5G 1X5, Canada.
Gut. 2012 Oct;61(10):1410-6. doi: 10.1136/gutjnl-2011-301978. Epub 2012 Jun 8.
To evaluate the impact of in-hospital gastroenterologist care, relative to other provider care, on health outcomes of hospitalised Ulcerative colitis (UC) patients.
A population-based cohort study of 4278 UC patients hospitalised between 2002 and 2008 was conducted in Ontario, Canada. The primary outcome was in-hospital mortality risk.
UC patients admitted under non-gastroenterologists had a higher in-hospital mortality rate (1.1 vs 0.2%, p<0.0001) but a similar in-hospital colectomy rate (5.4 vs 4.9%, p=0.69) as compared to UC patients admitted under gastroenterologists. Following covariate adjustment, non-gastroenterologist care was associated with a greater in-hospital mortality risk relative to gastroenterologist care (adjusted OR (aOR) 3.28, 95% CI 1.03 to 10.5). This increased mortality risk was observed in patients admitted to other internists (OR 5.49, 95% CI 1.75 to 17.2) and general practitioners (OR 6.02, 95% CI 1.84 to 19.7), with a trend towards greater mortality risk among patients admitted to general surgeons (OR 3.49, 95% CI 0.90 to 13.6). Among patients who were discharged from hospital colectomy-free, those who were admitted under non-gastroenterologists had a greater one-year risk of death than patients who were admitted under gastroenterologists (adjusted HR 2.07, 95% CI 1.26 to 3.40). The type of hospital provider did not impact in-hospital or one-year colectomy risks or the risk of hospital re-admission in this cohort.
Primary in-hospital gastroenterologist care was associated with decreased in-hospital and one-year mortality risks among hospitalised UC patients. Optimised care strategies by experienced specialists may confer important health advantages in this patient population.
评估与其他医生相比，住院溃疡性结肠炎（UC）患者的院内肠胃病医生治疗对健康结果的影响。
对 2002 年至 2008 年期间在加拿大安大略省住院的 4278 名 UC 患者进行了一项基于人群的队列研究。主要结局是院内死亡率风险。
与肠胃病医生收治的 UC 患者相比，非肠胃病医生收治的 UC 患者的院内死亡率更高（1.1%比 0.2%，p<0.0001），但院内结肠切除术率相似（5.4%比 4.9%，p=0.69）。在校正协变量后，非肠胃病医生治疗与肠胃病医生治疗相比，与更大的院内死亡率风险相关（调整后的比值比[aOR]3.28，95%置信区间[CI]1.03 至 10.5）。在收治于其他内科医生（OR 5.49，95%CI 1.75 至 17.2）和全科医生（OR 6.02，95%CI 1.84 至 19.7）的患者中观察到这种增加的死亡率风险，而在收治于普通外科医生的患者中，死亡率风险有增加的趋势（OR 3.49，95%CI 0.90 至 13.6）。在出院时无结肠切除术且无并发症的患者中，与收治于肠胃病医生的患者相比，收治于非肠胃病医生的患者在一年内死亡的风险更高（调整后的 HR 2.07，95%CI 1.26 至 3.40）。在该队列中，医院提供者的类型并不影响院内或一年内结肠切除术风险或再次住院风险。
初级院内肠胃病医生治疗与住院 UC 患者的院内和一年死亡率风险降低相关。经验丰富的专家制定的优化治疗策略可能为该患者群体带来重要的健康优势。
