4.7 Article

Outcomes in high and low volume hospitals in patients with acute hematochezia in a cohort study

Journal

SCIENTIFIC REPORTS
Volume 11, Issue 1, Pages -

Publisher

NATURE PORTFOLIO
DOI: 10.1038/s41598-021-99832-6

Keywords

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Funding

  1. Ministry of Health, Labour and Welfare, Japan [19HB1003]
  2. JSPS KAKENHI [JP17K09365, 20K08366]
  3. Smoking Research Foundation
  4. Takeda Science Foundation
  5. National Center for Global Health and Medicine [292001, 29-2004, 19A1011, 19A1022, 19A-2015, 29-1025, 30-1020]
  6. Grants-in-Aid for Scientific Research [20K08366] Funding Source: KAKEN

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A cohort study compared outcomes of acute hematochezia patients in high- versus low-volume hospitals, finding no significant difference in rebleeding rates but a higher mortality rate in high-volume hospitals. High-volume hospitals did not significantly impact rebleeding but had a significant effect on death within 30 days.
Outcomes of acute lower gastrointestinal bleeding have not been compared according to hospital capacity. We aimed to perform a propensity score-matched cohort study with path and mediation analyses for acute hematochezia patients. Hospitals were divided into high- versus low-volume hospitals for emergency medical services. Rebleeding and death within 30 days were compared. Computed tomography, early colonoscopy (colonoscopy performed within 24 h), and endoscopic therapies were included as mediators. A total of 2644 matched pairs were yielded. The rebleeding rate within 30 days was not significant between high- and low-volume hospitals (16% vs. 17%, P = 0.44). The mortality rate within 30 days was significantly higher in the high-volume cohort than in the low-volume cohort (1.7% vs. 0.8%, P = 0.003). Treatment at high-volume hospitals was not a significant factor for rebleeding (odds ratio [OR] = 0.91; 95% confidence interval [CI], 0.79-1.06; P = 0.23), but was significant for death within 30 days (OR = 2.03; 95% CI, 1.17-3.52; P = 0.012) on multivariate logistic regression after adjusting for patients' characteristics. Mediation effects were not observed, except for rebleeding within 30 days in high-volume hospitals through early colonoscopy. However, the direct effect of high-volume hospitals on rebleeding was not significant. High-volume hospitals did not improve the outcomes of acute hematochezia patients.

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