Yamamoto Hiroyuki, Hashimoto Hideki, Nakamura Mitsuhiro, Horiguchi Hiromasa, Yasunaga Hideo
Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan.
Clin Exp Nephrol. 2015 Apr;19(2):271-7. doi: 10.1007/s10157-014-0986-x. Epub 2014 May 31.
Although hemorrhagic complications are major complications of percutaneous renal biopsy (PRB), the relationship between procedure volume and morbidity remains unclear for PRB. The present study investigated the impact of hospital volume on the occurrence of hemorrhagic complications after PRB.
Using large claims-based data in the diagnosis procedure combination database in Japan, we identified inpatients with renal disorders who underwent PRB within 4 days after admission during July to December 2007 to 2010. We assessed patient age, sex, clinical syndromes, hemorrhagic complications and diagnoses, and annual hospital volume of PRB divided into quintiles. Multivariate logistic regression analyses fitted with a generalized estimation equation were performed accounting for within-hospital clustering.
A total of 15,191 patients were identified from 942 hospitals. The overall proportion of hemorrhagic complications was 2.1 %, including diagnoses of hemorrhagic events (1.6 %), red blood cell transfusion (0.5 %), and requiring angiography or endovascular procedure (0.1 %). In-hospital deaths attributable to the complications occurred in 0.06 % of the patients. Patients with rapidly progressive nephritic syndrome (odds ratio 3.41, 95 % confidence interval 2.22-5.25) had significantly higher incidence than those with chronic nephritic syndrome. No significant association was observed between hospital volume and hemorrhagic complications, with odds ratios for the low-intermediate, intermediate, intermediate-high, and high-volume groups relative to the low-volume group of 0.74 (0.43-1.26), 1.19 (0.74-1.92), 1.16 (0.67-2.00), and 1.35 (0.78-2.34), respectively.
No significant relationship was observed between hemorrhagic complication incidence and hospital volume regarding PRB.
尽管出血性并发症是经皮肾活检（PRB）的主要并发症，但PRB的操作量与发病率之间的关系仍不明确。本研究调查了医院操作量对PRB后出血性并发症发生情况的影响。
利用日本诊断程序组合数据库中基于索赔的大型数据，我们确定了2007年7月至2010年12月期间入院后4天内接受PRB的肾脏疾病住院患者。我们评估了患者的年龄、性别、临床综合征、出血性并发症及诊断，以及PRB的年度医院操作量，并将其分为五等份。采用广义估计方程进行多因素逻辑回归分析，以考虑医院内部的聚类情况。
从942家医院中识别出15191例患者。出血性并发症的总体比例为2.1%，包括出血事件诊断（1.6%）、红细胞输血（0.5%）以及需要进行血管造影或血管内操作（0.1%）。因并发症导致的院内死亡发生在0.06%的患者中。快速进行性肾炎综合征患者（比值比3.41，95%置信区间2.22 - 5.25）的发病率显著高于慢性肾炎综合征患者。未观察到医院操作量与出血性并发症之间存在显著关联，低 - 中级、中级、中 - 高级和高操作量组相对于低操作量组的比值比分别为0.74（0.43 - 1.26）、1.19（0.74 - 1.92）、1.16（0. [67 - 2.00]）和1.35（0.78 - 2.34）。
在PRB方面，未观察到出血性并发症发生率与医院操作量之间存在显著关系。
