Abstract
BackgroundWe investigated the relation between hospital volume and outcome in patients with severe acute pancreatitis (SAP). The determination is important because patient outcome may be improved through volume-based selective referral.MethodsIn this cohort study, we analyzed 22,551 SAP patients in 2,208 hospital-years (between 2000 and 2009) from Taiwan’s National Health Insurance Research Database. Primary outcome was hospital mortality. Secondary outcomes were hospital length of stay and charges. Hospital SAP volume was measured both as categorical and as continuous variables (per one case increase each hospital-year). The effect was assessed using multivariable logistic regression models with generalized estimating equations accounting for hospital clustering effect. Adjusted covariates included patient and hospital characteristics (model 1), and additional treatment variables (model 2).ResultsIrrespective of the measurements, increasing hospital volume was associated with reduced risk of hospital mortality after adjusting the patient and hospital characteristics (adjusted odds ratio [OR] 0.995, 95% confidence interval [CI] 0.993-0.998 for per one case increase). The patients treated in the highest volume quartile (≥14 cases per hospital-year) had 42% lower risk of hospital mortality than those in the lowest volume quartile (1 case per hospital-year) after adjusting the patient and hospital characteristics (adjusted OR 0.58, 95% CI 0.40-0.83). However, an inverse relation between volume and hospital stay or hospital charges was observed only when the volume was analyzed as a categorical variable. After adjusting the treatment covariates, the volume effect on hospital mortality disappeared regardless of the volume measures.ConclusionsThese findings support the use of volume-based selective referral for patients with SAP and suggest that differences in levels or processes of care among hospitals may have contributed to the volume effect.
Highlights
We investigated the relation between hospital volume and outcome in patients with severe acute pancreatitis (SAP)
Hospital volume was correlated with hospital level, ownership and geographic location
The results on hospital length of stay (LOS) and charges were somewhat dependent on the definition of volume measures, trend analyses suggested that higher hospital volume appeared to be associated with shorter stay and lower cost
Summary
We investigated the relation between hospital volume and outcome in patients with severe acute pancreatitis (SAP). The determination is important because patient outcome may be improved through volume-based selective referral. High-volume hospitals have shown to be more efficient and have better outcomes than lowvolume hospitals. Documentation of the volume-outcome relationship is important because patient outcomes may be improved through volume-based selective referral [1,3]. An inverse volume-outcome relationship was revealed in patients with acute pancreatitis (AP) [5,6]. Prior severe cases from a national cohort of patients with firstattack AP [12] to investigate the effect of hospital volume on patient outcomes
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