Acute variceal hemorrhage is an important complication of cirrhosis that carries a high mortality rate.
Management of acute variceal hemorrhage requires early initiation of specialized care that may be more readily available at centers that deal with a high volume of acute variceal hemorrhage.
Dr Ashwin Ananthakrishnan and colleagues from Wisconsin, USA examined the relationship between the annual hospitalization volume and the in-hospital mortality rate for acute variceal hemorrhage.
The research team undertook cross-sectional study from a national representative sample.
|Patients at medium- and high-volume hospitals were more likely to undergo TIPS|
|Gastrointestinal Endoscopy |
The team evaluated a 20% sample of all nonfederal short-term hospitals from 37 states participating in the Nationwide Inpatient Sample 2004.
The team assessed a total of 28,817 discharges with acute variceal hemorrhage.
The team identified the cases through appropriate International Classification of Diseases, 9th Revision, Clinical Modification codes for bleeding esophageal varices.
Hospitals were divided into low-, medium-, and high-volume hospitals if they had 1 to 15, 16 to 35, and 36 or more annual discharges related to acute variceal hemorrhage.
On multivariate analysis, the research team found no significant difference in the mortality rate either for medium- or high-volume hospitals.
However, patients both at medium- and high-volume hospitals were more likely to undergo endoscopy for acute variceal hemorrhage.
Endoscopic intervention for control of variceal hemorrhage was significantly more common in medium- and high-volume hospitals.
Patients at medium- and high-volume hospitals were also more likely to undergo transjugular intrahepatic portosystemic shunts (TIPS).
Dr Ananthakrishnan’s team concluded, “Higher hospital volume is associated with greater rates of endoscopy, endoscopic intervention, and higher utilization of transjugular intrahepatic portosystemic shunt in the management of acute variceal hemorrhage.”