Higher hospital volume is associated with lower mortality in acute nonvariceal upper-GI hemorrhage

Abstract

Background: Acute nonvariceal upper-GI hemorrhage (NVUGIH) is associated with significant morbidity and mortality.

Objective: To examine the relationship between hospital volume and outcomes of NVUGIH.

Design: A cross-sectional study.

Setting: Participating hospitals from the Nationwide Inpatient Sample 2004.

Patients: All discharged patients with a primary discharge diagnosis of NVUGIH based on the International Classification of Diseases, Clinical Modification, ninth edition codes.

Interventions: Patients were divided into 3 groups based on discharge from hospitals with annual discharge volumes of 1 to 125 (low), 126 to 250 (medium), and >250 (high).

Main outcome measurements: In-hospital mortality, length of stay, and hospitalization charges.

Results: The study included a total of 135,366, 132,746, and 123,007 discharges with NVUGIH occurred from low-volume, medium-volume, and high-volume hospitals, respectively. On multivariate analysis, when adjusting for age, comorbidity, and the presence of complications, patients at high-volume hospitals had significantly lower in-hospital mortality (odds ratio [OR] 0.85 [95% CI, 0.74-0.98]) than patients at low-volume hospitals. Patients at high-volume hospitals were also more likely to undergo upper-GI endoscopy (OR 1.52 [95% CI, 1.36-1.69]) or early endoscopy within 1 day of hospitalization compared with low-volume hospitals (60.5% vs 53.8%, adjusted OR 1.28 [95% CI, 1.02-1.61]). Undergoing endoscopy within day 1 was associated with shorter hospital stays (-1.08 days [95% CI, -1.24 to -0.92 days]) and lower hospitalization charges (-$1958 [95% CI, -$3227 to -$688]).

Limitations: The study was based on an administrative data set.

Conclusions: Higher hospital volume is associated with lower mortality and with higher rates of endoscopy and endoscopic intervention in patients with NVUGIH.