Hospital Volume and Other Risk Factors for In-Hospital Mortality among Diverticulitis Patients: A Nationwide Analysis

Abstract

BACKGROUND: Previous studies have found that a higher volume of colorectal surgery was associated with lower mortality rates. While diverticulitis is an increasingly common condition, the effect of hospital volume on outcomes among diverticulitis patients is unknown.OBJECTIVE: To evaluate the relationship between hospital volume and other factors on in-hospital mortality among patients admitted for diverticulitis.METHODS: Data from the Nationwide Inpatient Sample (years 1993 to 2008) were analyzed to identify 822,865 patients representing 4,108,726 admissions for diverticulitis. Hospitals were divided into quartiles based on the volume of diverticulitis cases admitted over the study period, adjusted for years contributed to the dataset. Mortality according to hospital volume was modelled using logistic regression adjusting for age, sex, race, comorbidities, health care insurance, admission type, calendar year, colectomy, disease severity and clustering. Risk estimates were expressed as adjusted ORs with 95% CIs.RESULTS: Patients at high-volume hospitals were more likely to be admitted emergently, undergo surgical treatment and have more severe disease. In-hospital mortality was higher among the lowest quartile of hospital volume compared with the highest volume (OR 1.13 [95% CI 1.05 to 1.21]). In-hospital mortality was increased among patients admitted emergently (OR 2.58 [95% CI 2.40 to 2.78]) as well as those receiving surgical treatment (OR 3.60 [95% CI 3.42 to 3.78]).CONCLUSIONS: Diverticulitis patients admitted to hospitals with a low volume of diverticulitis cases had an increased risk for death compared with those admitted to high-volume centres.

Dialysis Case Volume Associated With In-Hospital Mortality in Maintenance Dialysis Patients

“…Numerous prior studies have shown the beneficial effect of a large HV on clinical outcomes in a wide variety of diseases or in patients needing operations or procedures. 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 A larger HV is associated with larger caseloads and increased experience, and greater numbers of surgeons or physicians, both of which potentially lead to favorable outcomes for patients. 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 Admissions to larger HV and DCV hospitals both were associated with lower in-hospital mortality, as expected, in a univariate analysis.…”

“…Recent attempts to clarify the association between hospital volume (HV) and in-hospital mortality showed that a larger HV is associated with increased survival in various diseases such as sepsis, breast cancer, chronic obstructive pulmonary disease, acute myeloid leukemia, peripheral arterial disease, and deep vein thrombosis, 7 , 8 , 9 , 10 , 11 , 12 , 13 as well as after surgical procedures. 14 , 15 HV is usually defined as the number of hospitalization cases 7 , 8 , 9 , 10 , 11 or specific procedures 12 , 13 , 14 , 15 at each hospital. Thus, a larger HV is associated with a greater number of case experiences, doctors with expertise in treating the disease, hospital infrastructure, and resources.…”

Surgical treatment of uncomplicated diverticulitis in Switzerland: comparison of population‐based data over two time periods

“…Therefore, comparing results from this Swiss investigation with those of other studies may be difficult. Most data come from the US or from reports of single institutions or surgical departments . Etzioni et al .…”

“…Therefore, comparing results from this Swiss investigation with those of other studies may be difficult. Most data come from the US or from reports of single institutions or surgical departments [6,24,[36][37][38][39][40][41][42][43]. Etzioni et al reported elective resection rates of 14% for an inpatient sample in the US in the millennial years with a marked increase of 29% between 1998 and 2005, especially in younger patients [41].…”

Clinical Research Using the National Inpatient Sample: A Brief Review of Colorectal Studies Utilizing the NIS Database

“…They found that patients at higher volume hospitals were more likely to be admitted emergently and undergo surgery, with expected lower mortality. 41 There has also been a documented shift of colorectal cases from lowvolume centers to high-volume centers. 42,43 Higher volume hospitals were more likely to discharge patients home; they were also associated with a greater likelihood of discharge to 44 Conversely, disposition in lowvolume hospitals, specifically critical access hospitals, has a greater proportion of hospital transfers.…”