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.
|投稿者||Hamada, Tsuyoshi; Michihata, Nobuaki; Saito, Tomotaka; Iwashita, Takuji; Shiomi, Hideyuki; Takenaka, Mamoru; Matsui, Hiroki; Fushimi, Kiyohide; Isayama, Hiroyuki; Yasuda, Ichiro; Yasunaga, Hideo; Nakai, Yousuke|
|組織名||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:;firstname.lastname@example.org.;Department of Health Services Research, Graduate School of Medicine.;Department of Gastroenterology, Graduate School of Medicine.;First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.;Division of Gastroenterology and Hepatobiliary and Pancreatic Diseases,;Department of Internal Medicine, Hyogo Medical University, Hyogo, Japan.;Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai;University, Osaka, Japan.;Department of Clinical Epidemiology and Health Economics, School of Public;Health, The University of Tokyo, Tokyo, Japan.;Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo;Medical and Dental University, Tokyo, Japan.;Department of Gastroenterology, Graduate School of Medicine, Juntendo University,;Tokyo, Japan.;Third Department of Internal Medicine, University of Toyama, Toyama, Japan.;Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan.|