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Volume of hospital is important for the prognosis of high-risk patients with nonvariceal upper gastrointestinal bleeding (NVUGIB)

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Abstract

Background and aim

Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a potentially life-threatening hospital emergency requiring hemodynamic stabilization and resuscitation. This study is carried out to determine whether hospital volume can influence outcome in patients with NVUGIB.

Method

This is a retrospective study with a prospective cohort database (KCT 0000514. cris.nih.go.kr). Eight teaching hospitals were divided into two different groups: high-volume centers (HVC, ≥60 NVUGIB patients/year, four clinics) and low-volume centers (LVC, <60 NVUGIB patients/year, four clinics). Baseline characteristics of patients, risk stratification, and outcomes between hospitals of different volumes were compared. From February 2011 to December 2013, a total of 1584 NVUGIB patients enrolled in eight clinics were retrospectively reviewed. The main outcome measurements consisted of continuous bleeding after treatment, re-bleeding, necessity for surgical/other retreatments, and death within 30 days.

Results

Similar baseline characters for patients were observed in both groups. There was a significant difference in the incidence of poor outcome between the HVC and LVC groups (9.06 vs. 13.69%, P = 0.014). The incidence rate of poor outcome in high-risk patients (Rockall score ≥8) in HVC was lower than that in high-risk patients in LVC (16.07 vs. 26.92%, P = 0.048); however, there was no significant difference in poor outcome in the lower-risk patients in either group (8.72 vs. 10.42%, P = 0.370).

Conclusions

Significant correlation between hospital volume and outcome in NVUGIB patients was observed. Referral to HVC for the management of high-risk NVUGIB patients should be considered in clinical practice.

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Authors and Affiliations

  1. Department of Internal Medicine, Kyungpook National University Medical Center, Daegu, Korea

    Jin Woo Choi & Seong Woo Jeon

  2. Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea

    Jung Gu Kwon & Dong Wook Lee

  3. Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea

    Chang Yoon Ha

  4. Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea

    Kwang Bum Cho

  5. Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea

    Byung Ik Jang

  6. Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea

    Jung Bae Park

  7. Department of Internal Medicine, Soonchunhyang University Hospital, Gumi, Korea

    Youn Sun Park

  8. Kyungpook National University Hospital/School of Medicine, 807 Hoguk-ro, Buk-gu, Daegu, 41404, Korea

    Jin Woo Choi & Seong Woo Jeon

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  1. Jin Woo Choi
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Correspondence to Seong Woo Jeon.

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Disclosures

Jin Woo Choi, Seong Woo Jeon, Jung Gu Kwon, Dong Wook Lee, Chang Yoon Ha, Kwang Bum Cho, Byung Ik Jang, Jung Bae Park, and Youn Sun Park have no conflict of interest or financial ties to disclose.

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Choi, J.W., Jeon, S.W., Kwon, J.G. et al. Volume of hospital is important for the prognosis of high-risk patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). Surg Endosc 31, 3339–3346 (2017). https://doi.org/10.1007/s00464-016-5369-9

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  • DOI: https://doi.org/10.1007/s00464-016-5369-9

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