Influence of comorbidity on outcomes of older patients with acute pancreatitis based on a national administrative database

BACKGROUND: Little information is available on the influence of comorbidities on outcomes of older patients with acute pancreatitis. This study aimed to investigate the influence of comorbidities on outcomes of older patients with acute pancreatitis using data from a national Japanese administrative database.METHODS: A total of 14 322 older patients(≥70 years) with acute pancreatitis were referred to 1090 hospitals between 2010 and 2012 in Japan. We collected patients' data from the administrative database to compare the in-hospital mortality and length of stay of older patients with acute pancreatitis.The patients were categorized into four groups according to comorbidity level using the Charlson Comorbidity Index(CCI): none(CCI score=0; n=6890); mild(1; n=3874); moderate(2; n=2192) and severe(≥3; n=1366).RESULTS: Multiple logistic and linear regression analyses revealed that severe comorbidity was significantly associated with higher in-hospital mortality and longer length of stay[odds ratio(OR)=2.26; 95% confidence interval(CI): 1.75-2.92P0.001 and coefficient 4.37 days; 95% CI: 2.89-5.85, P0.001respectively]. In addition, cardiovascular and renal diseases were the most significant comorbidities affecting outcomes of the older patients. ORs of cardiovascular and renal diseases for mortality were 1.44(95% CI: 1.13-1.85, P=0.003) and 2.69(95% CI: 1.88-3.85, P0.001), respectively, and coefficients forlength of stay were 3.01 days(95% CI: 1.34-4.67, P0.001) and 3.72 days(95% CI: 1.01-6.42, P=0.007), respectively.CONCLUSION: This study demonstrated that comorbidities significantly influenced outcomes of older patients with acute pancreatitis and cardiovascular and renal comorbidities were significant factors affecting outcomes.     

Impact of hospital volume on clinical outcomes of endoscopic biliary drainage for acute cholangitis based on the Japanese administrative database associated with the diagnosis procedure combination system

Background  

We aimed to determine the relationship between hospital volume and the clinical outcomes of endoscopic biliary drainage for acute cholangitis, using the Japanese administrative database associated with the diagnosis procedure combination (DPC) system.     

Ambient temperature and hospital admissions for acute cholecystitis: a nationwide inpatient database study in Japan

BackgroundThe incidence of acute cholecystitis has a seasonal peak in summer. However, the reason for such seasonality remains unclear. This retrospective cohort study was performed to examine the association between ambient temperature and acute cholecystitis.MethodsWe identified admissions for acute cholecystitis from January 2011 to December 2017 from a nationwide inpatient database in Japan. We performed a Poisson regression analysis to investigate the association between ambient temperature and admission for acute cholecystitis with adjustment for relative humidity, national holidays, day of the week, and year. We accounted for clustering of the outcome within prefectures using a generalized estimating equation.ResultsWe analyzed 601 665 admissions for acute cholecystitis. With an ambient temperature of 5.0 °C–9.9 °C as a reference, Poisson regression showed that the number of admissions increased significantly with increasing temperature (highest above 30 °C; relative risk, 1.35; 95% confidence interval, 1.34–1.37). An ambient temperature of <5.0 °C was also associated with higher admission for acute cholecystitis than an ambient temperature of 5.0 °C–9.9 °C (relative risk, 1.23; 95% confidence interval, 1.21–1.25).ConclusionThe present nationwide Japanese inpatient database study showed that high temperature (≥10.0 °C) and low temperature (<5.0 °C) were associated with increased admission for acute cholecystitis.     

Impact of surgical volume on nationwide hospital mortality after pancreaticoduodenectomy

AIM: To evaluate the impact of surgical volume on nationwide hospital mortality after pancreaticoduodenectomy (PD) for periampullary tumors in South Korea.METHODS: Periampullary cancer patients who underwent PD between 2005 and 2008 were analyzed from the database of the Health Insurance Review and Assessment Service of South Korea. A total of 126 hospitals were divided into 5 categories, each similar in terms of surgical volume for each category. We used hospital mortality as a quality indicator, which was defined as death during the hospital stay for PD, and calculated adjusted mortality through multivariate logistic models using several confounder variables.RESULTS: A total of eligible 4975 patients were enrolled in this study. Average annual surgical volume of hospitals was markedly varied, ranging from 215 PDs in the very-high-volume hospital to < 10 PDs in the very-low-volume hospitals. Admission route, type of medical security, and type of operation were significantly different by surgical volume. The overall hospital mortality was 2.1% and the observed hospital mortality by surgical volume showed statistical difference. Surgical volume, age, and type of operation were independent risk factors for hospital death, and adjusted hospital mortality showed a similar difference between hospitals with observed mortality. The result of the Hosmer-Lemeshow test was 5.76 (P = 0.674), indicating an acceptable appropriateness of our regression model.CONCLUSION: The higher-volume hospitals showed lower hospital mortality than the lower-volume hospitals after PD in South Korea, which were clarified through the nationwide database.     

Association between hospital volume and outcomes of elderly and non‐elderly patients with acute biliary diseases: A national administrative database analysis

Aim: This study aimed to investigate the relationship between hospital volume and clinical outcomes of elderly and non‐elderly patients with acute biliary diseases using data from a national administrative database. Methods: Overall, 26 720 elderly and 33 774 non‐elderly patients with acute biliary diseases were referred to 820 hospitals in Japan. Hospital volume was categorized into three groups based on the case numbers during the study period: low‐volume, medium‐volume and high‐volume. We compared the risk‐adjusted length of stay (LOS) and in‐hospital mortality in relation to hospital volume. These analyses were stratified according to the presence of invasive treatments for acute biliary diseases. Results: Multiple linear regression analyses showed that increased hospital volume was significantly associated with shorter LOS in both elderly and non‐elderly patients with and without invasive treatments. Increased hospital volume was significantly associated with decreased relative risk of in‐hospital mortality in elderly patients. The odds ratio for high‐volume hospitals was 0.672 in elderly patients without invasive treatments (95% confidence interval [CI] 0.533–0.847, P = 0.001) and 0.715 in those with invasive treatments (95% C, 0.566–0.904, P = 0.005). However, no significant differences for in‐hospital mortality were seen in non‐elderly patients with and without invasive treatments. Conclusion: This study has highlighted that higher volume hospitals significantly reduced LOS and in‐hospital mortality for elderly patients with acute biliary diseases, but not non‐elderly patients. The current results are of value for elderly healthcare policy decision‐making, and highlight the need for further studies into the quality of care for elderly patients. Geriatr Gerontol Int 2013; 13: 731–740.     

Prognostic impact of hospital volume on familial adenomatous polyposis: a nationwide multicenter study

Purpose

Many studies have shown that hospital volume is significantly associated with short- and long-term outcomes in various diseases, including cancer. However, there have been no reports discussing the relationship between hospital volume and familial adenomatous polyposis (FAP). This study aimed to clarify whether hospital volume affects short- and long-term outcomes in FAP patients.

Methods

We established a retrospectively collected database of FAP patients who underwent initial surgical treatment at 23 Japanese institutions during 2000–2012. Factors associated with short- and long-term outcomes were analyzed.

Results

The study cohort included 303 FAP patients. These patients were classified into tertile categories according to hospital volume: low (n = 31), middle (n = 72), and high volume (n = 200). The proportion of only adenoma/stage 0 was comparable among tertile categories. The adoption of operative procedure significantly differed among tertile categories; specifically, high-volume institutions preferred handsewn ileal pouch-anal anastomosis without diverting ileostomy (P < 0.001 and < 0.001, respectively). Nevertheless, the frequency of complications with Clavien-Dindo classification grade ≥ 3 was not significantly different among tertile categories. Functional results were acceptable in every category. Wexner scores were significantly lower in high-volume compared to low-volume institutions (P = 0.02). Multivariate analyses showed that UICC stage and hospital volume were significantly associated with overall survival (P = 0.04 and 0.03, respectively).

Conclusions

Hospital volume was significantly associated with short- and long-term outcomes in FAP patients.

     

Evaluation of cholecystectomy in older individuals using real-world data: a multilevel analysis based on a nationwide administrative database in Japan

Journal of Gastroenterology - In the present study, we aimed to evaluate the clinical outcomes of cholecystectomy in older individuals. In this retrospective study, data from the Japanese Diagnosis...     

Hospital volume and outcomes of pancreatic cancer: a Finnish population-based nationwide study

BackgroundPancreatic cancer surgery is associated with high incidence of short- and long-term morbidity and mortality. The aim of this study was to assess whether the hospital volume of pancreatic surgery is associated with better survival in a population-based setting.MethodsAll patients who underwent pancreatic resection for cancer in Finland during 1997–2016 were identified from nationwide registries. The follow-up ended on 31 December 2019. Patients were divided into quintiles based on annual hospital volume (4-year moving average): ≤4, 5–9, 10–18, 19–36 and ≥ 37 resections per year. Cox regression provided hazard ratios (HR) and 95% confidence intervals (CI), adjusted for age, sex, comorbidity and year of surgery.ResultsThe number of diagnosed pancreatic cancers was 22,724. Of these, 1514 underwent pancreatic surgery due to pancreatic ductal adenocarcinoma. The 5-year survival ranged from 12% to 28%, increasing with higher annual operative volume. Adjusted 5-year mortality was higher in all other quintiles compared to the highest annual volume quintile (HR 1.43, 95% CI 1.16–1.75). Thirty and 90-day mortality were higher in the three lowest volume, compared to the highest quintile.ConclusionHigher annual hospital volume of pancreatic surgery for pancreatic ductal adenocarcinoma is associated with improved short- and long-term survival.     

Multivariate analysis of factors influencing medical costs of acute pancreatitis hospitalizations based on a national administrative database

BackgroundLittle information is available on the analysis of medical costs of acute pancreatitis hospitalizations.AimThis study aimed to determine the factors affecting medical costs of patients with acute pancreatitis during hospitalization using a Japanese administrative database.MethodsA total of 7193 patients with acute pancreatitis were referred to 776 hospitals. We defined “patients with high medical costs” as patients whose medical costs exceeded the 90th percentile in medical costs during hospitalization and identified the independent factors for patients with high medical costs with and without controlling for length of stay.ResultsMultiple logistic regression analysis demonstrated that necrosectomy was the most significant factor for medical costs of acute pancreatitis during hospitalization. The odds ratio of necrosectomy was 33.64 (95% confidence interval, 14.14–80.03; p < 0.001). Use of an intensive care unit was the most significant factor for medical costs after controlling for LOS. The OR of an ICU was 6.44 (95% CI, 4.72–8.81; p < 0.001).ConclusionThis study demonstrated that necrosectomy and use of an ICU significantly affected the medical costs of acute pancreatitis hospitalization. These results highlight the need for health care implementations to reduce medical costs whilst maintaining the quality of patient care, and targeting patients with severe acute pancreatitis.     

Impact of initial antibiotic choice on clinical outcomes in community-acquired pneumonia: analysis of a hospital claims-made database

BACKGROUND: Much controversy exists regarding the initial choice of antibiotics and selected outcomes for patients with community-acquired pneumonia (CAP). METHODS: The investigators analyzed a hospital claims-made database to assess the impact of initial antibiotic choice on 30-day mortality, total hospital costs, and hospital length of stay (LOS). Fine risk groups allowed for stratification for variations in the severity of illness. Patients were divided into five monotherapy groups (ie, ceftriaxone, "other" cephalosporins, fluoroquinolones, macrolides, or penicillins) and four groups that received dual therapy (ie, the agents listed above, except macrolides) plus macrolides. Patients also were stratified by age (ie, > 65 years of age and < 65 years of age). Severely ill patients were excluded. RESULTS: Overall, 44,814 persons met the criteria for inclusion. Among monotherapy patients, those who received macrolides had the least mortality but were the least ill. Patients who received dual therapy generally had shorter LOSs, lower total hospital charges, and decreased mortality compared with those who received monotherapy. Differences among dual-therapy regimens regarding outcomes studies were noted. Patients who were < 65 years of age had lower mortality rates, shorter LOSs, and lower hospital charges than did the more elderly patients. Within this group, those who received dual therapy had better outcomes than those who received monotherapy. CONCLUSIONS: We confirmed the value of dual therapy employing macrolides as a second agent in decreasing mortality from CAP, and we provided similar data regarding shorter LOSs and lower hospital charges. This appears to hold for a younger population. Differences among dual-therapy regimens (all employing macrolides) appear to exist and may be clinically relevant.     

The impact of the institutional abdominoperineal resections volume on short-term outcomes and expenses: a nationwide study

Techniques in Coloproctology - The aim of this study was to evaluate the influence of the institutional volume of abdominoperineal resections (APR) on the short-term outcomes and costs in the...     

影响重症胰腺炎预后的早期危险因素分析

目的探讨影响重症急性胰腺炎（severe acute pancreatitis,SAP）预后的早期危险因素。方法回顾性分析2000年1月至2010年12月间我院收治的SAP患者90例,按预后分为死亡组（37例）和生存组（53例）。分析比较两组患者临床资料及人院24h内实验室检查指标的差异,并通过Logistic回归分析筛选与预后有关的危险因素。结果死亡组患者年龄、血糖显著高于生存组（JP〈0．05）。死亡组患者动脉血氧分压、血钙、血清白蛋白显著低于生存组（P〈0．05）。高龄（OR=1．589．95％CI：1．195～2．114,P〈0．05）,动脉血氧分压（OR=0．055,95％CI：0．004—0．700,P〈0．05）、血清白蛋白（OR=0．850,95％CI：0．752～0．960,P〈0．05）是影响SAP预后的早期因素。结论高龄、低动脉血氧分压、低血清白蛋白可能是影响SAP预后的早期危险因素。     

Clinical features of chronic pancreatitis in Korea: a multicenter nationwide study

BACKGROUND/AIMS: No reliable nationwide clinical data about chronic pancreatitis (CP) was available in Korea. The etiology and clinical features of CP were investigated using a multicenter nationwide study. METHODS: 814 cases of CP were enrolled retrospectively over the past 4 years at 13 hospitals. The following data were obtained from all patients: etiology, symptoms, complications, and surgery. RESULT: Alcohol (64.3%) was the major cause of CP and idiopathic CP (20.8%) was the second most common form. Mean patient age was 50.6 years and the male:female ratio was 6:1 (24:1 for alcoholic CP vs. 2:1 in idiopathic CP, p < 0.001). Diabetes (31.6%), pseudocysts (28.4%), biliary stricture (13.9%), and pancreatic ascites (6.6%) were the main complications. Of these, diabetes (35 vs. 26%) and pseudocyst (33.7 vs. 21.9%) were more frequent in alcoholic than in idiopathic CP. Pancreatic cancer developed in 25 patients (3.1%) during follow-up and their mean age was 59.1 years. CONCLUSIONS: In Korea, alcohol is the most common etiology of CP. Moreover, diabetes and pseudocysts are frequent complications, especially in alcoholic CP, and pancreatic cancer development is not infrequent.     

Timing of cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis: a nationwide inpatient database study

BackgroundOptimal interval from percutaneous transhepatic gallbladder drainage (PTGBD) to cholecystectomy for acute cholecystitis remains unclear.MethodsWe analyzed patients undergoing cholecystectomy following PTGBD for acute cholecystitis, using a national database. We performed restricted cubic spline (RCS) analyses to investigate the association of interval from PTGBD to cholecystectomy with outcomes (mortality/morbidity, blood transfusion, duration of anesthesia, and postoperative hospital stay).ResultsAmong 9,256 patients, RCS analyses showed reverse J-shaped associations of the interval with mortality/morbidity and blood transfusion, and J-shaped associations of the interval with both duration of anesthesia and postoperative hospital stay. Each interval was compared with the bottom of the spline curve. Patients with intervals ≤6 days or ≥27 days had higher mortality/morbidity than those with a 10-day interval. Patients with intervals ≤8 days had higher proportions of blood transfusion than those with a 10-day interval. Patients with intervals ≥17 days had longer duration of anesthesia than those with a 5-day interval. Postoperative hospital stay was longer among those with intervals ≤10 days or ≥19 days than those with a 15-day interval.ConclusionsBased on the mortality/morbidity data, the optimum time to perform cholecystectomy is between 7 and 26 days after PTGBD.     

Statin-induced lupus: a case/non-case study in a nationwide pharmacovigilance database

Statin use has been advocated to prevent atheromatous complications in lupus patients and may be widely prescribed for these patients in future. Statin-induced lupus has also been described, though the risk is not confirmed. The goal of this study was to detect a safety signal regarding statin-induced lupus. We conducted a case/non-case study in the French PharmacoVigilance Database from January 2000 until December 2010. Cases were drug-induced lupus reports. Non-cases were all reports of other adverse drug reactions (ADRs). Exposure to statins at the time of ADR was screened in each report. Among 235,147 ADR reports, 232 were drug-induced lupus. Exposure to statins was present in 17 (7.3%) cases and in 10,601 (4.7%) non-cases. Reporting odds ratio (ROR) for statin exposure associated with lupus erythematosus was 1.67 (95% confidence interval 1.02-2.74). The ROR was?>?1 for each statin but fluvastatin. This pharmacoepidemiological study suggests a link between statin exposure and lupus induction. The benefit-to-risk ratio of statin therapy in lupus patients should be evaluated through randomized controlled trials.     

The recent time trend of outcomes of disseminated intravascular coagulation in Japan: an observational study based on a national administrative database

The aim of this study is to investigate the recent trend over time of outcomes of patients with disseminated intravascular coagulation (DIC) based on the Japanese administrative database. A total of 34,711 patients with DIC had been referred to 1,092 hospitals from 2010 to 2012 in Japan. We collected patients’ data from the administrative database to compare in-hospital mortality within 14 and 28 days between periods. The study periods were categorized into three groups: 2010 (n = 8,382), 2011 (n = 13,372), and 2012 (n = 12,957). These analyses were performed according to the underlying diseases associated with DIC. The in-hospital mortality within 14 or 28 days of DIC patients with infectious diseases decreased between 2010 and 2012 (within 14 days: 20.4 vs. 18.1 vs. 17.9 %, P = 0.009; within 28 days: 31.1 vs. 28.7 vs. 27.7 %, P = 0.003; respectively). Multiple logistic regressions also showed that the period was associated with in-hospital mortality of DIC patients with infectious diseases. The odds ratios of 2011 and 2012 for in-hospital mortality within 14 days were 0.86 [95 % confidence intervals (CI) 0.77–0.97] and 0.84 (95 % CI 0.75–0.94) whereas those for in-hospital mortality within 28 days were 0.89 (95 % CI 0.81–0.98) and 0.83 (95 % CI 0.76–0.92), respectively. However, there were no significant differences in mortality of patients with DIC associated with other underlying diseases between 2010 and 2012. This study demonstrated that in-hospital mortality of DIC patients with infectious diseases gradually improved between 2010 and 2012 in Japan.