Department of Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, UH I-248, Newark, NJ, 07101, USA.
Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ, USA.
Surg Endosc. 2021 Jan;35(1):326-332. doi: 10.1007/s00464-020-07403-z. Epub 2020 Feb 6.
Our aim was to assess the differences in outcomes of cholecystitis, pancreatitis, gastrointestinal (GI) bleed, GI perforation, and mortality in teaching versus nonteaching hospitals nationwide among therapeutic and diagnostic ERCPs. We hypothesized that complication rates would be higher in teaching hospitals given greater patient complexity.
Inpatient diagnostic and therapeutic ERCPs were identified from the National Inpatient Sample (NIS) from 2008 to 2012. The presence of ACGME-approved residency programs is required to qualify as a teaching hospital. Nonteaching urban and rural hospitals were grouped together. We identified hospital stays complicated by pancreatitis, cholecystitis, GI hemorrhage, perforation, and mortality. Logistic regression propensity-matched analysis was performed in SPSS to compare differences in complication rates between teaching and nonteaching hospitals.
A total of 1,466,356 weighted cases of inpatient ERCPs were included in this study: of those, 367 and188 were diagnostic, 1,099,168 were therapeutic, 766,230 were at teaching hospitals, and 700,126 were at nonteaching hospitals. Mortality rates were higher in teaching hospitals when compared to nonteaching hospitals for diagnostic (OR 1.266, p < 0.001) and therapeutic ERCPs (OR 1.157, p = 0.001). There was no significant difference in rates of post-ERCP cholecystitis, pancreatitis, or perforation between the two groups. Among diagnostic ERCPs, GI hemorrhage was higher in teaching compared to nonteaching hospitals (OR 1.181, p = 0.003). Likewise, length of stay was increased in teaching hospitals (7.9 vs 6.9 days, p < 0.001, for diagnostic and 6.5 vs 5.8 days, p < 0.001, for therapeutic ERCPs).
In conclusion, teaching hospitals were noted to have a higher mortality rate associated with inpatient ERCPs as well as higher rates of GI hemorrhage in diagnostic ERCPs, which may be due to a higher comorbidity index in those patients admitted to teaching hospitals.
我们的目的是评估全美教学医院与非教学医院之间治疗性和诊断性内镜逆行胰胆管造影术（ERCP）的胆囊炎、胰腺炎、胃肠道（GI）出血、GI 穿孔和死亡率的结果差异。我们假设，鉴于患者病情更为复杂，教学医院的并发症发生率会更高。
从 2008 年至 2012 年，从国家住院患者样本（NIS）中确定了住院诊断性和治疗性 ERCP。只有获得 ACGME 批准的住院医师培训计划的医院才有资格成为教学医院。非教学城市和农村医院被归为一组。我们确定了胰腺炎、胆囊炎、GI 出血、穿孔和死亡率等住院并发症。使用 SPSS 进行逻辑回归倾向匹配分析，以比较教学医院与非教学医院之间并发症发生率的差异。
本研究共纳入 1466356 例住院 ERCP 加权病例：其中 367 例和 188 例为诊断性，1099168 例为治疗性，766230 例在教学医院，700126 例在非教学医院。与非教学医院相比，教学医院的诊断性（OR 1.266，p<0.001）和治疗性 ERCP （OR 1.157，p=0.001）的死亡率更高。两组之间 ERCP 后胆囊炎、胰腺炎或穿孔的发生率没有显著差异。在诊断性 ERCP 中，与非教学医院相比，教学医院的胃肠道出血率更高（OR 1.181，p=0.003）。同样，教学医院的住院时间延长（诊断性 ERCP 为 7.9 天 vs 6.9 天，p<0.001；治疗性 ERCP 为 6.5 天 vs 5.8 天，p<0.001）。
总之，教学医院与住院 ERCP 相关的死亡率更高，诊断性 ERCP 的胃肠道出血率也更高，这可能是由于教学医院收治的患者合并症指数更高所致。
