Esophageal variceal bleeding has a high mortality rate and requires complex management.
High provider volume has been associated with improved outcomes for various surgical procedures and medical diagnoses, and volume-based referral has been advocated.
Dr Robert Myers and colleagues from Canada assessed the volume-outcome relationship in patients with esophageal variceal bleeding.
The research team analyzed the 1998 to 2005 Nationwide Inpatient Sample to identify patients hospitalized for esophageal variceal bleeding.
The effects of hospital volume on in-hospital mortality, length of stay, and hospital charges were evaluated.
The researchers used logistic regression models with adjustment for demographic and clinical factors for the analyses.
Hospital volume was classified on the basis of the average annual number of esophageal variceal bleeding admissions during the study interval.
The research team found that between 1998 and 2005, there were 36,807 hospitalizations in 2575 hospitals for esophageal variceal bleeding.
The researchers noted that 76% of the hospitals were low-volume centers.
Overall, in-hospital mortality was 11%, the median length of stay was 4 days, and total per patient charges were $21,144.
Compared with low-volume centers, admission to a high-volume hospital was associated with an increased risk of death, prolonged stay, and increased total charges.
The team observed that patients admitted to high-volume hospitals were more likely to have negative prognostic characteristics.
The negative prognostic characteristics included male gender, non-white race, nonprivate health insurance, alcoholic cirrhosis, hepatic decompensation, and transferral from another institution.
After adjusting for case mix, the team found that volume was not an independent predictor of in-hospital mortality or length of stay.
However, medium- and high-volume centers had increased total charges.
Dr Myers and team commented, "The volume-outcome relationship observed for some procedures and conditions does not apply to patients with esophageal variceal bleeding."
"Therefore, volume-based referral is not indicated to improve short-term outcomes in this condition."