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Impact of hospital volume on clinical outcomes of endoscopic biliary drainage for acute cholangitis based on the Japanese administrative database associated with the diagnosis procedure combination system

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

We aimed to determine the relationship between hospital volume and the clinical outcomes of endoscopic biliary drainage for acute cholangitis, using the Japanese administrative database associated with the diagnosis procedure combination (DPC) system.

Methods

A total of 8698 patients with endoscopic biliary drainage were referred to 654 hospitals. We corrected patients’ data from the database to compare risk-adjusted length of stay (LOS) and drainage-related complications in relation to the hospital volume. Hospital volume was categorized into three groups based on number of cases during the study period: low-volume hospitals (LVHs; <16 cases), medium-volume hospitals (MVHs; 16–32 cases), and high-volume hospitals (HVHs; >32 cases).

Results

Significant variation in mean LOS was observed between hospital volume categories (26.8 ± 22.6 days in LVHs vs. 23.3 ± 21.5 days in MVHs vs. 19.7 ± 17.2 days in HVHs, P < 0.001). There was a significant difference with regard to complications of endoscopic biliary drainage (5.6% in LVHs vs. 4.3% in MVHs vs. 3.2% in HVHs, P < 0.001). Multiple linear regression analysis revealed that hospital volume was most significantly associated with a decrease in risk-adjusted LOS. The standardized coefficient of MVHs was −0.155, whereas that of HVHs was −0.802. Multiple logistic regression analysis showed that hospital volume decreased the relative risk of drainage-related complications. The odds ratio (OR) of MVHs was 0.764 [95% confidence interval (CI), 0.604–0.965], whereas the OR of HVHs was 0.561 (95% CI, 0.434–0.725).

Conclusions

There was a significant association between hospital volume and the clinical outcomes of endoscopic biliary drainage for acute cholangitis.

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Acknowledgments

We gratefully thank Dr. Truong-Minh Pham for his kind help in statistical analysis. This study was funded by Grants-in-Aid for Research on Policy Planning and Evaluation from the Ministry of Health, Labour and Welfare, Japan.

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Authors and Affiliations

  1. Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan

    Atsuhiko Murata, Shinya Matsuda, Yoshihisa Fujino & Tatsuhiko Kubo

  2. Department of Health Care Administration and Management, Graduate School of Medicine, Kyushu University, Fukuoka, Japan

    Kazuaki Kuwabara

  3. Division of Medical Management, Hokkaido University Hospital, Hokkaido, Japan

    Kenji Fujimori

  4. Department of Health Management and Policy, Graduate School of Medicine, Tokyo University, Tokyo, Japan

    Hiromasa Horiguchi

Authors
  1. Atsuhiko Murata
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  2. Shinya Matsuda
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  3. Kazuaki Kuwabara
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  4. Yoshihisa Fujino
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  5. Tatsuhiko Kubo
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  6. Kenji Fujimori
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  7. Hiromasa Horiguchi
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Correspondence to Atsuhiko Murata.

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Murata, A., Matsuda, S., Kuwabara, K. et al. Impact of hospital volume on clinical outcomes of endoscopic biliary drainage for acute cholangitis based on the Japanese administrative database associated with the diagnosis procedure combination system. J Gastroenterol 45, 1090–1096 (2010). https://doi.org/10.1007/s00535-010-0257-x

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  • DOI: https://doi.org/10.1007/s00535-010-0257-x

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