Does It Matter Where You Are Hospitalized for Inflammatory Bowel Disease? A Nationwide Analysis of Hospital Volume

OBJECTIVE: To examine if a high hospital volume was associated with superior outcomes in inflammatory bowel disease (IBD) patients requiring hospitalization.METHODS: This was a cross-sectional study using data from the Nationwide Inpatient Sample (NIS 2004). IBD-related hospitalizations were identified using appropriate International Classification of Diseases, Ninth revision, Clinical modification (ICD-9-CM) codes. Hospital volume was divided into low, medium, and high by assigning the threshold cutoff values of 1–50, 51–150, and >150 annual IBD hospitalizations, respectively. Our primary outcomes were in-hospital mortality, length of stay, and postoperative complications and stay.RESULTS: Patients at high-volume centers were more likely to be hospitalized with fistulizing or stricturing disease. The adjusted mortality was lower for IBD-related discharges from high-volume centers for those undergoing abdominal surgery (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.18–0.78), but not among those who did not undergo surgery (OR 0.90, 95% CI 0.53–1.52). Patients at high-volume centers were also more likely to undergo surgery (OR 2.24, 95% CI 1.40–3.58). These differences were more prominent in Crohn's disease than in ulcerative colitis.CONCLUSION: Hospitals with a high annual IBD volume have lower in-hospital mortality among surgical IBD patients. This suggests a need for future research into identifying the quality-of-care measures in IBD and instituting appropriate interventions to improve overall IBD outcomes.

[1]  G. Kaplan,et al.  Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. , 2008, Gastroenterology.

[2]  N. Powe,et al.  Race and health insurance are predictors of hospitalized Crohn's disease patients undergoing bowel resection , 2007, Inflammatory bowel diseases.

[3]  S. Targan,et al.  Differences in the management of Crohn’s disease among experts and community providers, based on a national survey of sample case vignettes , 2007, Alimentary pharmacology & therapeutics.

[4]  K. V. Steeg.  The volume-outcome debate revisited. , 2007, The American surgeon.

[5]  A. Griffiths,et al.  Intercenter variation in initial management of children with Crohn's disease , 2007, Inflammatory bowel diseases.

[6]  B. Feagan.  Medical Management of Ulcerative Colitis in 2006: What's on the Horizon? , 2007, The American Journal of Gastroenterology.

[7]  J. Lewis,et al.  Trends in hospitalization rates for inflammatory bowel disease in the United States. , 2007, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[8]  P. Munkholm,et al.  Changes in Clinical Characteristics, Course, and Prognosis of Inflammatory Bowel Disease during the Last 5 Decades: A Population‐Based Study from Copenhagen, Denmark , 2007, Inflammatory bowel diseases.

[9]  D. Litwin,et al.  National outcomes after gastric resection for neoplasm. , 2007, Archives of surgery.

[10]  M. Koelemay,et al.  Relation between hospital volume and outcome of elective surgery for abdominal aortic aneurysm: a systematic review. , 2007, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[11]  A. Pierro,et al.  A systematic review of the impact of volume of surgery and specialization on patient outcome , 2007, The British journal of surgery.

[12]  Purushottam W. Laud,et al.  Relationship between number of breast cancer operations performed and 5-year survival after treatment for early-stage breast cancer. , 2007, American journal of public health.

[13]  S. Finlayson,et al.  Small rural hospitals and high-risk operations: how would regionalization affect surgical volume and hospital revenue? , 2006, Journal of the American College of Surgeons.

[14]  C. O'Morain,et al.  Cost analysis and cost determinants in a European inflammatory bowel disease inception cohort with 10 years of follow-up evaluation. , 2006, Gastroenterology.

[15]  P. Pronovost,et al.  Hospital volume and mortality for mechanical ventilation of medical and surgical patients: A population-based analysis using administrative data* , 2006, Critical care medicine.

[16]  D. Morgan,et al.  The Burden of Gastrointestinal and Liver Diseases, 2006 , 2006, The American Journal of Gastroenterology.

[17]  Herng‐Ching Lin,et al.  Hospital Volume and Inpatient Mortality After Cancer-Related Gastrointestinal Resections: The Experience of an Asian Country , 2006, Annals of Surgical Oncology.

[18]  T. Osler,et al.  Impact of patient volume on the mortality rate of adult intensive care unit patients , 2006, Critical care medicine.

[19]  P. Munkholm,et al.  Increasing Incidences of Inflammatory Bowel Disease and Decreasing Surgery Rates in Copenhagen City and County, 2003–2005: A Population-Based Study from the Danish Crohn Colitis Database , 2006, The American Journal of Gastroenterology.

[20]  D. Rampton,et al.  Optimizing quality of outpatient care for patients with inflammatory bowel disease: the importance of specialist clinics , 2006, European journal of gastroenterology & hepatology.

[21]  C. Bernstein,et al.  Hospitalization, Surgery, and Readmission Rates of IBD in Canada: A Population-Based Study , 2006, The American Journal of Gastroenterology.

[22]  S. Varadarajulu,et al.  Relationship among hospital ERCP volume, length of stay, and technical outcomes. , 2005, Gastrointestinal endoscopy.

[23]  Tom Hughes-Davies,et al.  Hospital volume and outcomes of mechanical ventilation. , 2006, The New England journal of medicine.

[24]  G. Rogler,et al.  Crohn's disease patient characteristics in a tertiary referral center: comparison with patients from a population-based cohort , 2005, European journal of gastroenterology & hepatology.

[25]  P. Williamson,et al.  Cost of illness of inflammatory bowel disease in the UK: a single centre retrospective study , 2004, Gut.

[26]  Robert E Harbaugh,et al.  Surgeon Volume and Operative Mortality in the United States. , 2004, Neurosurgery.

[27]  John A. Cowan,et al.  Hospital teaching status and outcomes of complex surgical procedures in the United States. , 2004, Archives of surgery.

[28]  H. Krumholz,et al.  Hospital Coronary Artery Bypass Graft Surgery Volume and Patient Mortality, 1998–2000 , 2004, Annals of surgery.

[29]  A. Thuraisingam,et al.  Medical management of ulcerative colitis. , 2003, Hospital medicine.

[30]  J. Meyerhardt,et al.  Association of Hospital Procedure Volume and Outcomes in Patients with Colon Cancer at High Risk for Recurrence , 2003, Annals of Internal Medicine.

[31]  John A. Cowan,et al.  Hospital volume and surgical outcomes for elderly patients with colorectal cancer in the United States. , 2003, The Journal of surgical research.

[32]  J. Birkmeyer,et al.  Hospital volume and operative mortality in cancer surgery: a national study. , 2003, Archives of surgery.

[33]  John A. Cowan,et al.  Surgical treatment of intact thoracoabdominal aortic aneurysms in the United States: hospital and surgeon volume-related outcomes. , 2003, Journal of vascular surgery.

[34]  J. Dimick,et al.  Hospital volume-related differences in aorto-bifemoral bypass operative mortality in the United States. , 2003, Journal of vascular surgery.

[35]  Irene Fraser,et al.  Volume thresholds and hospital characteristics in the United States. , 2003, Health affairs.

[36]  Hollister Avenue.  2000 HCUP NATIONWIDE INPATIENT SAMPLE (NIS) COMPARISON REPORT , 2003 .

[37]  Ethan A Halm,et al.  Is Volume Related to Outcome in Health Care? A Systematic Review and Methodologic Critique of the Literature , 2002, Annals of Internal Medicine.

[38]  Anne Elixhauser,et al.  The healthcare cost and utilization project: an overview. , 2002, Effective clinical practice : ECP.

[39]  C. Begg,et al.  The influence of hospital volume on survival after resection for lung cancer. , 2001, The New England journal of medicine.

[40]  C. Begg,et al.  Influence of hospital procedure volume on outcomes following surgery for colon cancer. , 2000, JAMA.

[41]  M. Bala,et al.  Annual cost of care for Crohn's disease: a payor perspective , 2000, American Journal of Gastroenterology.

[42]  C. Bernstein,et al.  Direct hospital costs for patients with inflammatory bowel disease in a Canadian Tertiary Care University Hospital , 2000, American Journal of Gastroenterology.

[43]  D. Jewell,et al.  A Simple Classification of Crohn's Disease: Report of the Working Party for the World Congresses of Gastroenterology, Vienna 1998 , 2000, Inflammatory bowel diseases.

[44]  P. Rosenbaum,et al.  Invited commentary: propensity scores. , 1999, American journal of epidemiology.

[45]  N. Powe,et al.  The association between hospital volume and survival after acute myocardial infarction in elderly patients. , 1999, The New England journal of medicine.

[46]  G. Cooper,et al.  Severity-adjusted mortality and length of stay in teaching and nonteaching hospitals. Results of a regional study. , 1998, JAMA.

[47]  Donald Rubin,et al.  Estimating Causal Effects from Large Data Sets Using Propensity Scores , 1997, Annals of Internal Medicine.

[48]  R. Wenzel,et al.  Regionalization of Tertiary Care: Impact of Safe Cardiovascular Volumes in Iowa , 1997, Health services management research.

[49]  R. Brook,et al.  Regionalization of Cardiac Surgery in the United States and Canada , 1996 .

[50]  R. Brook,et al.  Regionalization of cardiac surgery in the United States and Canada. Geographic access, choice, and outcomes. , 1995, JAMA.

[51]  D. Pryor,et al.  The relation between the volume of coronary angioplasty procedures at hospitals treating Medicare beneficiaries and short-term mortality. , 1994, The New England journal of medicine.

[52]  R. Deyo,et al.  Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. , 1992, Journal of clinical epidemiology.

[53]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.