Inverse association of hospital volume with in-hospital mortality rate of patients receiving EUS-guided interventions for pancreatic fluid collections

Tsuyoshi Hamada; Nobuaki Michihata; Tomotaka Saito; Takuji Iwashita; Hideyuki Shiomi; Mamoru Takenaka; Hiroki Matsui; Kiyohide Fushimi; Hiroyuki Isayama; Ichiro Yasuda; Hideo Yasunaga; Yousuke Nakai; WONDERFUL study group in Japan and collaborators

doi:10.1016/j.gie.2023.04.2091

Inverse association of hospital volume with in-hospital mortality rate of patients receiving EUS-guided interventions for pancreatic fluid collections

Gastrointest Endosc. 2023 Oct;98(4):597-606.e2. doi: 10.1016/j.gie.2023.04.2091. Epub 2023 May 5.

Affiliations

¹ Department of Gastroenterology, Graduate School of Medicine; Department of Hepato-Biliary-Pancreatic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan. Electronic address: hamada-tky@umin.ac.jp.
² Department of Health Services Research, Graduate School of Medicine.
³ Department of Gastroenterology, Graduate School of Medicine.
⁴ First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
⁵ Division of Gastroenterology and Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Hyogo Medical University, Hyogo, Japan.
⁶ Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan.
⁷ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
⁸ Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
⁹ Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
¹⁰ Third Department of Internal Medicine, University of Toyama, Toyama, Japan.
¹¹ Department of Gastroenterology, Graduate School of Medicine; Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan.

PMID: 37150410
DOI: 10.1016/j.gie.2023.04.2091

Abstract

Background and aims: EUS-guided interventions currently serve as first-line treatment for symptomatic pancreatic fluid collections (PFCs) but require high-level expertise and multidisciplinary care. Hospital caseload has not been fully examined in relation to clinical outcomes of patients with endoscopically managed PFCs.

Methods: Using the Diagnosis Procedure Combination database (a Japanese nationwide inpatient database), we identified 4053 patients receiving EUS-guided treatment of PFCs at 486 hospitals between 2010 and 2020 and examined an association of hospital volume (average annual number of cases at a hospital) with in-hospital mortality. Associations with bleeding, length of stay, and total costs were examined as secondary analyses. Multivariable logistic regression analysis was conducted with adjustment for potential confounders.

Results: The hospital volume was inversely associated with the risk of in-hospital mortality (P_trend < .001). The adjusted odds ratio for in-hospital mortality comparing the extreme quintiles of hospital volume was .17 (95% confidence interval, .09-.33). A restricted cubic spline analysis yielded no statistically significant evidence on the nonlinear relationship (P_nonlinearity = .19). The types of stents (plastic vs lumen-apposing metal stent) seemed to have no effect modification on the volume-mortality relationship (P_interaction = .58). Higher hospital volume was also associated with lower risk of bleeding, shorter length of stay, and lower medical costs of inpatient care.

Conclusions: Higher hospital volume was associated with a lower risk of in-hospital mortality of patients receiving EUS-guided treatment of PFCs. A further investigation is warranted to justify the volume-based selective referral of the patients.

MeSH terms

Databases, Factual
Hospital Mortality
Hospitalization
Hospitals*
Humans
Odds Ratio
Pancreatic Diseases* / therapy