Decreasing in-hospital mortality for oesophageal variceal hemorrhage in the USA.
BACKGROUND
To date, no study has analyzed nationwide trends of in-hospital mortality related to oesophageal variceal hemorrhage in the USA. The aim of this study was to analyze trends of in-hospital mortality related to oesophageal variceal bleeding over the past two decades using a large national database. In addition, our aim was to study patient demographics and to identify risk factors for in-hospital mortality based on administrative data routinely collected in this population.


METHODS
The nationwide inpatient sample database was used from 1988 to 2004. Patients with an International Classification of Diseases, ninth revision, Clinical Modification discharge diagnosis of oesophageal variceal bleeding were included. Patient demographics, hospital, and admission characteristics were collected. t-test and Poisson regression analysis were used to evaluate trends. Logistic regression analysis was performed to determine the relationship between mortality and patient/hospital characteristics.


RESULTS
From 1988 to 2004, crude in-hospital mortality decreased from 18 to 11.5%, whereas the age-adjusted in-hospital mortality rate decreased 45.4% from 1289 per 100,000 to 704 per 100,000 (P<0.01). Mortality was consistently higher for males and for African-Americans over the study period. For the 2001 dataset, multivariate logistic regression analysis showed that male sex, African-American race, age, large hospital size, urban location, teaching hospitals, and hospitals located in the northeast were independent risk factors for increased mortality.


CONCLUSIONS
The in-hospital mortality of patients with oesophageal variceal bleeding has decreased over the past two decades and is likely due to the advances made in the acute management of variceal bleeding as well as improved resuscitative methods. Male sex, African-American race, age, large hospital size, urban location, teaching hospitals, and hospitals located in the northeast are independent risk factors for increased in-hospital mortality.
Jamal
M Mazen
MM
Division of Gastroenterology, Veterans Affairs Medical Center, Long Beach, California 90822, USA. jamalm@uci.edu
Samarasena
Jason B
JB
Hashemzadeh
Mehrtash
M
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001509:Bed Occupancy; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000208:ethnology / Q000401:mortality*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000208:ethnology / Q000209:etiology / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends*; D006753:Hospital Records; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D014505:Urban Population