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

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.