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Erschienen in:
01.10.2008 | Original Article
Hospital Case Volume and Clinical Outcomes for Peptic Ulcer Treatment
Erschienen in: Journal of General Internal Medicine | Ausgabe 10/2008
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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.