Advertisement

Journal of General Internal Medicine

, Volume 23, Issue 10, pp 1693–1697 | Cite as

Hospital Case Volume and Clinical Outcomes for Peptic Ulcer Treatment

  • Horng-Yuan Lou
  • Herng-Ching Lin
  • Kuan-Yang Chen
Original Article

Abstract

Background

No study has explored the volume–outcome relationship for peptic ulcer treatment.

Objective

To investigate the association between peptic ulcer case volume per hospital, on the one hand, and in-hospital mortality and 14-day readmission rates, on the other, using a nationwide population-based dataset.

Design

A retrospective cross-sectional study, set in Taiwan.

Participants

There were 48,250 peptic ulcer patients included. Each patient was assigned to one of three hospital volume groups: low-volume (≤189 case), medium volume (190–410 cases), and high volume (≥411 cases).

Measurements

Logistic regression analysis employing generalized estimating equations was used to examine the adjusted relationship of hospital volume with in-hospital mortality and 14-day readmission.

Main Results

After adjusting for other factors, results showed that the likelihood of in-hospital mortality for peptic ulcer patients treated by low-volume hospitals (mortality rate = 0.68%) was 1.6 times (p < 0.05) that of those treated in high-volume hospitals (mortality rate = 0.72%) and 1.4 times (p < 0.05) that of those treated in medium-volume hospitals (mortality rate = 0.73%). The adjusted odds ratio of 14-day readmission likewise declined with increasing hospital volume, with the odds of 14-day readmission for those patients treated by low-volume hospitals being 1.5 times (p < 0.001) greater than for high-volume hospitals and 1.3 times (p < 0.01) greater than for medium-volume hospitals.

Conclusions

We found that, after adjusting for other factors, peptic ulcer patients treated in the low-volume hospitals had inferior clinical outcomes compared to those treated in medium-volume or high-volume ones.

KEY WORDS

ulcer volume–outcome mortality 

Notes

Conflict of Interest

None disclosed.

References

  1. 1.
    Sonnenberg A. Peptic ulcer. In: Everhart, JE, eds. Digestive diseases in the United States: epidemiology and impact. Washington, DC: US Department of Health and Human Services, Public Health Service, National Institutes of Health; 1994:359–408NIH publication no. 94–1447.Google Scholar
  2. 2.
    Freeman ML. Adverse outcomes of endoscopic retrograde cholangiopancreatography: Avoidance and management. Gastrointest Endosc Clin N Am. 2003;13:775–98.PubMedCrossRefGoogle Scholar
  3. 3.
    Gordon TA, Bowman HM, Bass EB, et al. Complex gastrointestinal surgery: impact of provider experience on clinical and economic outcomes. J Am Coll Surg. 1999;189:46–56.PubMedCrossRefGoogle Scholar
  4. 4.
    Dudley RA, Johansen KL, Brand R, et al. Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA. 2000;283:1159–66.PubMedCrossRefGoogle Scholar
  5. 5.
    Jollis JG, Peterson ED, DeLong ER, et al. The relation between the volume of coronary angioplasty procedures at hospitals treating Medicare beneficiaries and short-term mortality. N Engl J Med. 1994;334:1625–9.CrossRefGoogle Scholar
  6. 6.
    Jollis JG, Peterson ED, Nelson CL, et al. Relationship between physician and hospital coronary angioplasty volume and outcome in elderly patients. Circulation. 1997;95:2485–91.PubMedGoogle Scholar
  7. 7.
    Hannan EL, Racz M, Ryan TJ, et al. Coronary angioplasty volume–outcome relationships for hospitals and cardiologists. JAMA. 1997;277:892–8.PubMedCrossRefGoogle Scholar
  8. 8.
    McGrath PD, Wennberg ED, Dickens JD, et al. Relation between operator and hospital volume and outcomes following percutaneous coronary interventions in the era of the coronary stent. JAMA. 2000;284:3139–44.PubMedCrossRefGoogle Scholar
  9. 9.
    Varadarajulu S, Kilgore ML, Wilcox CM, et al. Relationship among hospital ERCP volume, length of stay, and technical outcomes. Gastrointest Endosc. 2006;64:338–47.PubMedCrossRefGoogle Scholar
  10. 10.
    Sacks HS, Chalmers TC, Blum AL, et al. Endoscopic hemostasis. An effective therapy for bleeding peptic ulcers. JAMA. 1990;264:494–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Cooper GS, Chak A, Connors AF, et al. The effectiveness of early endoscopy for upper gastrointestinal hemorrhage. Med Care. 1998;36:462–74.PubMedCrossRefGoogle Scholar
  12. 12.
    Cooper GS, Chak A, Way L, et al. Early endoscopy in upper gastrointestinal hemorrhage: association with recurrent bleeding, surgery, and length of hospital stay. Gastrointest Endosc. 1999;49:145–52.PubMedCrossRefGoogle Scholar
  13. 13.
    Tu JV, Sykora K, Naylor CD. Assessing the outcomes of coronary artery bypass graft surgery: how many risk factors are enough? Steering Committee of the Cardiac Care Network of Ontario. J Am Coll Cardiol. 1997;30:1317–23.PubMedCrossRefGoogle Scholar
  14. 14.
    Jones RH, Hannan EL, Hammermeister KE, et al. Identification of preoperative variables needed for risk adjustment of short-term mortality after coronary artery bypass graft surgery. The Working Group Panel on the Cooperative CABG Database Project. J Am Coll Cardiol. 1996;28:1478–87.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Horng-Yuan Lou
    • 1
    • 2
  • Herng-Ching Lin
    • 3
  • Kuan-Yang Chen
    • 4
  1. 1.Department of Internal Medicine, Division of GastroenterologyTaipei Medical University HospitalTaipeiTaiwan
  2. 2.College of Medicine, Department of Internal MedicineTaipei Medical UniversityTaipeiTaiwan
  3. 3.School of Health Care AdministrationTaipei Medical UniversityTaipeiTaiwan
  4. 4.Ren-Ai Branch, Department of Internal Medicine, Division of GastroenterologyTaipei City HospitalTaipeiTaiwan

Personalised recommendations