Sharbatji Mohamad, Anand Sachin Prabhu, Abhishek Ravinuthala, Ali Saeed, Ur Rahman Asad
Internal Medicine, AdventHealth Orlando, Orlando, USA.
Internal Medicine, University of Illinois Chicago, Chicago, USA.
Cureus. 2024 Jun 6;16(6):e61793. doi: 10.7759/cureus.61793. eCollection 2024 Jun.
BACKGROUND/AIMS: Studies have varied results regarding the impact of the teaching and non-teaching status of hospitals on the outcomes for hospitalized patients with upper gastrointestinal bleeding (UGIB). To evaluate these outcomes, we conducted a retrospective cohort study using the 2014 National Inpatient Sample (NIS) database.
We included all adult patients who were admitted with the principal diagnosis of UGIB. Patients admitted to rural and urban non-teaching hospitals were classified as non-teaching, whereas those admitted to urban teaching hospitals were classified as teaching. The main outcomes of interest were in-hospital mortality, percentage of patients requiring inpatient endoscopy, and endoscopic therapy, packed red blood cell (PRBC) transfusion, length of stay (LOS), and total hospitalization charges.
The study included 132,085 (97%) with nonvariceal UGIB (NVUGIB) and 4,200 (3%) with variceal UGIB (VUGIB). Of them, 62% were managed at teaching hospitals. Compared with admitted patients at non-teaching hospitals, patients with nonvariceal UGIB admitted at teaching hospitals had similar adjusted in-hospital mortality rates (adjusted odds ratio (OR): 0.97, 95% confidence interval (CI): 0.79-1.19), inpatient endoscopy rates (OR: 0.98, 95% CI: 0.91-1.1), and early endoscopy rates (within 24 hours) (OR: 0.98, 95% CI: 0.91-1.1) and lower PRBC transfusion rates (OR: 0.87, 95% CI: 0.79-0.97) but higher endoscopic therapy rates (OR: 1.3, 95% CI: 1.2-1.4), length of stay (mean increase of 0.43 days) (P<0.01), and total hospital charges (mean increase of $4,369) (P<0.01). Patients with variceal UGIB had similar adjusted in-hospital mortality rates (OR: 1.2, 95% CI: 0.61-2.3), inpatient endoscopy rates (OR: 0.97, 95% CI: 0.67-1.4), early endoscopy rates (within 24 hours) (OR: 0.97, 95% CI: 0.67-1.4), endoscopic therapy rates (OR: 2.5, 95% CI: 0.54- 11.2), and total hospital charges (P=0.45), and lower PRBC transfusion rates (OR: 0.63, 95% CI: 0.45-0.88) but higher length of stay (mean increase of 0.69 days) (P=0.02).
Patients with nonvariceal UGIB treated at US teaching hospitals and non-teaching hospitals have similar mortality, rates of in-hospital endoscopy, and early endoscopy, but teaching hospitals have higher rates of in-hospital therapeutic endoscopy, length of stay, and total hospital charges. There was no difference in any of the outcomes for variceal gastrointestinal (GI) bleeding treated at teaching hospitals compared with those treated at non-teaching hospitals, except for length of stay, which was higher among patients admitted to teaching hospitals compared to those admitted to non-teaching hospitals.
背景/目的：关于医院的教学与非教学状态对住院的上消化道出血（UGIB）患者治疗结果的影响，各项研究结果不一。为评估这些结果，我们使用2014年全国住院患者样本（NIS）数据库进行了一项回顾性队列研究。
我们纳入了所有以UGIB作为主要诊断入院的成年患者。入住农村和城市非教学医院的患者被归类为非教学组，而入住城市教学医院的患者被归类为教学组。主要关注的结果包括住院死亡率、需要住院内镜检查的患者百分比、内镜治疗、浓缩红细胞（PRBC）输注、住院时间（LOS）以及总住院费用。
该研究纳入了132,085例（97%）非静脉曲张性上消化道出血（NVUGIB）患者和4,200例（3%）静脉曲张性上消化道出血（VUGIB）患者。其中，62%的患者在教学医院接受治疗。与在非教学医院入院的患者相比，在教学医院入院的非静脉曲张性上消化道出血患者的调整后住院死亡率相似（调整后的优势比（OR）：0.97，95%置信区间（CI）：0.79 - 1.19）、住院内镜检查率（OR：0.98，95% CI：0.91 - 1.1）以及早期内镜检查率（24小时内）（OR：0.98，95% CI：0.91 - 1.1），PRBC输注率较低（OR：0.87，95% CI：0.79 - 0.97），但内镜治疗率较高（OR：1.3，95% CI：1.2 - 1.4）、住院时间（平均增加0.43天）（P<0.01）以及总住院费用（平均增加4369美元）（P<0.01）。静脉曲张性上消化道出血患者的调整后住院死亡率相似（OR：1.2，95% CI：0.61 - 2.3）、住院内镜检查率（OR：0.97，95% CI：0.67 - 1.4）、早期内镜检查率（24小时内）（OR：0.97，95% CI：0.67 - 1.4）、内镜治疗率（OR：2.5，95% CI：0.54 - 11.2）以及总住院费用（P = 0.45），PRBC输注率较低（OR：0.63，95% CI：0.45 - 0.88），但住院时间较长（平均增加0.69天）（P = 0.02）。
在美国教学医院和非教学医院接受治疗的非静脉曲张性上消化道出血患者的死亡率、住院内镜检查率和早期内镜检查率相似，但教学医院的住院治疗性内镜检查率、住院时间和总住院费用较高。与在非教学医院接受治疗的静脉曲张性胃肠道（GI）出血患者相比，在教学医院接受治疗的患者在任何结果上均无差异，但住院时间除外，教学医院入院患者的住院时间高于非教学医院入院患者。
