Effect of Center Volume on Outcomes in Hospitalized Patients With Hereditary Hemorrhagic Telangiectasia.
Mayo Clin Proc
; 91(12): 1753-1760, 2016 Dec.
Article
em En
| MEDLINE
| ID: mdl-27814895
ABSTRACT
OBJECTIVE:
To determine whether hospitalized patients with hereditary hemorrhagic telangiectasia (HHT) had better outcomes at high-volume treatment centers (HVCs). PATIENTS ANDMETHODS:
The Nationwide Inpatient Sample (2000-2011) was used to identify HHT-related hospitalizations. Hospitals were classified based on quartiles of annual HHT discharge volume. The 75th percentile cutoff value (third quartile) was used to classify hospitals as low-volume centers (1-7 HHT discharges per year) or as HVCs (≥8 discharges per year. Demographic features, complication rates, and outcomes were compared between the 2 groups.RESULTS:
We identified 9440 hospital discharges in patients with HHT. Of these patients, 6856 (72.6%) were admitted to low-volume centers and 2584 (27.4%) to HVCs. The former were more likely to be of white race, older, and with higher income levels (P<.001 for each). The HVCs had higher rates of anemia, epistaxis, congestive heart failure, pulmonary hypertension, and cerebral and pulmonary arteriovenous malformations and lower rates of ischemic stroke and myocardial infarction. After adjusting for baseline differences in a multivariate model, patients treated at HVCs were more likely to be discharged home (odds ratio [OR]=1.35; 95% CI, 1.21-1.52; P<.001) and less likely to be discharged to short-term rehabilitation facilities (OR=0.45; 95% CI, 0.31-0.64; P<.001). Patients treated at HVCs also had a significantly lower risk of in-hospital mortality (OR=0.51; 95% CI, 0.34-0.74; P<.001).CONCLUSION:
Patients with HHT hospitalized at HVCs had better outcomes, with lower in-hospital mortality and higher home discharge rates. These findings strongly support ongoing efforts to expand access to HHT centers of excellence in the United States and worldwide.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Telangiectasia Hemorrágica Hereditária
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Hospitais com Alto Volume de Atendimentos
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Hospitais com Baixo Volume de Atendimentos
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Pacientes Internados
Tipo de estudo:
Prognostic_studies
Limite:
Female
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Humans
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Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Mayo Clin Proc
Ano de publicação:
2016
Tipo de documento:
Article