医院教学状况对急性胆管炎结局的影响：美国住院患者的倾向匹配分析
Impact of Hospital Teaching Status on Outcomes of Acute Cholangitis: A Propensity-Matched Analysis of Hospitalizations in the United States.
作者信息
Yagnik Karan J, Patel Raj, Sonaiya Sneh, Parikh Charmy, Patel Pranav, Shah Yash, Hayat Umar, Dahiya Dushyant Singh, Radadiya Dhruvil, Bharadwaj Hareesha Rishab, Du Doantrang, Terrany Ben, Kaswala Dharmesh, Confer Bradley, Khara Harshit S
机构信息
Department of Medicine, Rutgers School of Medicine/Monmouth Medical Center, Long Branch, NJ 07740, USA.
Department of Medicine, St. Mary Medical Center, Langhorne, PA 19047, USA.
出版信息
Gastroenterology Res. 2025 Jun;18(3):129-138. doi: 10.14740/gr2038. Epub 2025 Jun 4.
BACKGROUND
Acute cholangitis (AC) is a serious condition caused by partial or complete obstruction of the common bile duct (CBD), leading to biliary tract infection. We aimed to evaluate whether teaching hospitals with trainees and non-teaching hospitals impact the outcome of AC in the United States.
METHODS
This study utilized the National Inpatient Sample database to analyze adult hospitalizations (> 18 years old) with a primary diagnosis of AC in the USA from 2016 to 2020. A multivariate logistic regression along with Chi-square and -tests was performed using SAS 9.4 software to analyze inpatient AC-associated mortality, inflation-adjusted total hospitalization costs (THC), and length of stay (LOS) in US teaching and non-teaching hospitals during the study period.
RESULTS
This study included a total of 30,300 patients, out of whom 23,535 (about 78%) were managed in teaching hospitals and 6,765 (about 22%) were managed in non-teaching hospitals. Primary outcomes showed a significant increase in mortality for patients managed in teaching hospitals (2.77% vs. 2.08%, P = 0.01) in comparison to non-teaching hospitals, hospital LOS was slightly higher in teaching hospitals (5 days (interquartile range (IQR): 3 - 6) vs. 4 days (IQR: 3 - 8)) and so did hospital cost ($15,259 vs. $14,506) in comparison to non-teaching hospitals. Secondary outcomes showed that patients in teaching hospitals had higher incidence of septic shock (16.06% vs. 12.53%, P < 0.0001), intensive care unit (ICU) admissions (6.61% vs. 5.07%, P = 0.0002), and intubation (5.30% vs. 3.46%, P < 0.0001) in comparison to non-teaching hospitals.
CONCLUSION
Our study found higher mortality rates for AC patients in teaching hospitals compared to non-teaching hospitals. Teaching hospitals also had higher rates of septic shock, ICU admission, and intubation, with no difference in endoscopic retrograde cholangiopancreatography (ERCP) use. These differences could be due to several factors, such as greater resident and fellow autonomy in teaching hospitals and a potentially more proactive approach by physicians in non-teaching hospitals. Additionally, teaching hospitals often manage more complex, higher-acuity cases, which could contribute to worse outcomes.
背景
急性胆管炎（AC）是一种由胆总管（CBD）部分或完全梗阻引起的严重疾病，可导致胆道感染。我们旨在评估美国有实习生的教学医院和非教学医院对急性胆管炎治疗结果的影响。
方法
本研究利用国家住院患者样本数据库，分析了2016年至2020年在美国以急性胆管炎为主要诊断的成年住院患者（>18岁）。使用SAS 9.4软件进行多因素逻辑回归分析以及卡方检验和t检验，以分析研究期间美国教学医院和非教学医院中与住院急性胆管炎相关的死亡率、通胀调整后的总住院费用（THC）和住院时间（LOS）。
结果
本研究共纳入30300例患者，其中23535例（约78%）在教学医院接受治疗，6765例（约22%）在非教学医院接受治疗。主要结果显示，与非教学医院相比，教学医院治疗的患者死亡率显著增加（2.77%对2.08%，P = 0.01），教学医院的住院时间略长（5天（四分位间距（IQR）：3 - 6）对4天（IQR：3 - 8）），住院费用也更高（15259美元对14506美元）。次要结果显示，与非教学医院相比，教学医院的患者感染性休克发生率更高（16.06%对12.53%，P < 0.0001）、重症监护病房（ICU）入院率更高（6.61%对5.07%，P = 0.0002）和插管率更高（5.30%对3.46%，P < 0.0001）。
结论
我们的研究发现，与非教学医院相比，教学医院中急性胆管炎患者的死亡率更高。教学医院的感染性休克、ICU入院和插管率也更高，在内镜逆行胰胆管造影（ERCP）的使用方面没有差异。这些差异可能是由于多种因素造成的，例如教学医院住院医师和研究员的自主权更大，以及非教学医院医生可能采取更积极的治疗方法。此外，教学医院通常处理更复杂、病情更严重的病例，这可能导致更差的治疗结果。
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