Patel Pavan, Rotundo Laura, Orosz Evan, Afridi Faiz, Pyrsopoulos Nikolaos
Division of Gastroenterology and Hepatology, Rutgers - New Jersey Medical School, Newark, NJ 07101-1709, United States.
Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ 07101-1709, United States.
World J Hepatol. 2020 Jun 27;12(6):288-297. doi: 10.4254/wjh.v12.i6.288.
Acute variceal bleeding is a major complication of portal hypertension and is a leading cause of death in patients with cirrhosis. There is limited data on the outcomes of patients with esophageal variceal bleeding in teaching versus nonteaching hospitals. Because esophageal variceal bleeding requires complex management, it may be hypothesized that teaching hospitals have lower mortality.
To assess the differences in mortality, hospital length of stay (LOS) and cost of admission for patients admitted for variceal bleed in teaching versus nonteaching hospitals across the US.
The National Inpatient Sample is the largest all-payer inpatient database consisting of approximately 20% of all inpatient admissions to nonfederal hospitals in the United States. We collected data from the years 2008 to 2014. Cases of variceal bleeding were identified using the International Classification of Diseases, Ninth Edition, Clinical Modification codes. Differences in mortality, LOS and cost were evaluated for patients with esophageal variceal bleed between teaching and nonteaching hospitals and adjusted for patient characteristics and comorbidities.
Between 2008 and 2014, there were 58362 cases of esophageal variceal bleeding identified. Compared with teaching hospitals, mortality was lower in non-teaching hospitals (8.0% 5.3%, < 0.001). Median LOS was shorter in nonteaching hospitals as compared to teaching hospitals (4 d 5 d, < 0.001). A higher proportion of non-white patients were managed in teaching hospitals. As far as procedures in nonteaching teaching hospitals, portosystemic shunt insertion (3.1% 6.9%, < 0.001) and balloon tamponade (0.6% 1.2%) were done more often in teaching hospitals while blood transfusions (64.2% 59.9%, = 0.001) were given more in nonteaching hospitals. Using binary logistic regression models and adjusting for baseline patient demographics and comorbid conditions the mortality, LOS and cost in teaching hospitals remained higher.
In patients admitted for esophageal variceal bleeding, mortality, length of stay and cost were higher in teaching hospitals versus nonteaching hospitals when controlling for other confounding factors.
急性静脉曲张出血是门静脉高压的主要并发症，也是肝硬化患者死亡的主要原因。关于教学医院与非教学医院中食管静脉曲张出血患者的治疗结果的数据有限。由于食管静脉曲张出血需要复杂的管理，因此可以推测教学医院的死亡率较低。
评估美国教学医院与非教学医院中因静脉曲张出血入院的患者在死亡率、住院时间（LOS）和住院费用方面的差异。
国家住院患者样本是最大的全支付者住院数据库，包含美国非联邦医院所有住院患者的约20%。我们收集了2008年至2014年的数据。使用国际疾病分类第九版临床修订版代码识别静脉曲张出血病例。评估教学医院与非教学医院中食管静脉曲张出血患者在死亡率、LOS和费用方面的差异，并根据患者特征和合并症进行调整。
2008年至2014年期间，共识别出58362例食管静脉曲张出血病例。与教学医院相比，非教学医院的死亡率较低（8.0%对5.3%，P<0.001）。与教学医院相比，非教学医院的中位LOS更短（4天对5天，P<0.001）。教学医院中管理的非白人患者比例更高。就非教学医院与教学医院的治疗程序而言，教学医院进行门体分流术（3.1%对6.9%，P<0.001）和气囊压迫术（0.6%对1.2%）的频率更高，而非教学医院输血（64.2%对59.9%，P=0.001）的比例更高。使用二元逻辑回归模型并根据基线患者人口统计学和合并症进行调整后，教学医院的死亡率、LOS和费用仍然更高。
在因食管静脉曲张出血入院的患者中，在控制其他混杂因素后，教学医院的死亡率、住院时间和费用高于非教学医院。
