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Impact of hospital volume on outcomes in acute pancreatitis: a study using a nationwide administrative database

  • Original Article—Liver, Pancreas, and Biliary Tract
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An Editorial to this article was published on 08 January 2014

Abstract

Background

Although several population-based studies have shown higher hospital volume (HV) to be associated with better outcomes in acute pancreatitis, they failed to adjust for disease severity and did not take into account the potentially non-linear relationship between HV and outcomes. Using a Japanese nationwide administrative database, this study aimed to evaluate the volume–outcome relationship in acute pancreatitis by means of statistical methods that permitted such considerations.

Methods

In-hospital mortality, length of stay, and total costs for patients with acute pancreatitis were analyzed using multivariate regression models fitted with generalized estimating equations. Adjustment for severity was based on the Japanese Severity Scoring System and other patient characteristics. We used restricted cubic spline functions to examine the potential non-linear relationships between HV and outcomes.

Results

In all, 17,415 eligible patients with acute pancreatitis were identified from 1,032 hospitals between 1 July 2010 and 30 September 2011. The in-hospital mortality rate was 2.6 %, and the median total costs were US $7,740 (interquartile range, 5,150–11,920). The overall and non-linear volume–outcome relationships were not significant either for in-hospital mortality or total costs. The median length of stay was 14 days (interquartile range, 10–22), and high HV was positively associated with shorter hospitalization (overall, P < 0.001; non-linear, P = 0.194).

Conclusions

Despite the shorter hospitalization with higher HV, no inverse volume–outcome relationship was evident for acute pancreatitis. Further evidence is required to justify the volume-based selective referral of acute pancreatitis patients.

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Acknowledgments

This study was funded by a Grant-in-Aid for Research on Policy Planning and Evaluation from the Ministry of Health, Labour and Welfare, Japan (Grant Number: H22-Policy-031), by a Grant-in-Aid for Scientific Research B (No. 22390131) from the Ministry of Education, Culture, Sports, Science and Technology, and by the Funding Program for World-Leading Innovative R&D on Science and Technology (FIRST program) from the Council for Science and Technology Policy, Japan (Grant Number: 0301002001001).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Tsuyoshi Hamada, Yousuke Nakai, Hiroyuki Isayama & Kazuhiko Koike

  2. Department of Health Economics and Epidemiology Research, School of Public Health, The University of Tokyo, Tokyo, Japan

    Hideo Yasunaga

  3. Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan

    Hiromasa Horiguchi

  4. Department of Health Care Informatics, Tokyo Medical and Dental University, Tokyo, Japan

    Kiyohide Fushimi

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  1. Tsuyoshi Hamada
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  2. Hideo Yasunaga
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  4. Hiroyuki Isayama
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Correspondence to Hiroyuki Isayama.

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Hamada, T., Yasunaga, H., Nakai, Y. et al. Impact of hospital volume on outcomes in acute pancreatitis: a study using a nationwide administrative database. J Gastroenterol 49, 148–155 (2014). https://doi.org/10.1007/s00535-013-0888-9

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  • DOI: https://doi.org/10.1007/s00535-013-0888-9

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