Jin Woo Choi1,2, Seong Woo Jeon3,4, Jung Gu Kwon5, Dong Wook Lee5, Chang Yoon Ha6, Kwang Bum Cho7, Byung Ik Jang8, Jung Bae Park9, Youn Sun Park10. 1. Department of Internal Medicine, Kyungpook National University Medical Center, Daegu, Korea. 2. Kyungpook National University Hospital/School of Medicine, 807 Hoguk-ro, Buk-gu, Daegu, 41404, Korea. 3. Department of Internal Medicine, Kyungpook National University Medical Center, Daegu, Korea. sw-jeon@hanmail.net. 4. Kyungpook National University Hospital/School of Medicine, 807 Hoguk-ro, Buk-gu, Daegu, 41404, Korea. sw-jeon@hanmail.net. 5. Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea. 6. Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea. 7. Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea. 8. Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea. 9. Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea. 10. Department of Internal Medicine, Soonchunhyang University Hospital, Gumi, Korea.
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.
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.
Entities:
Keywords:
Nonvariceal upper gastrointestinal bleeding; Outcomes; Prognosis; Volume of hospital
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