title: Volume of hospital is important for the prognosis of high-risk patients with nonvariceal upper gastrointestinal bleeding (NVUGIB).
abstract: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a potentially life-threatening hospital emergency requiring hemodynamic stabilization and resuscitation. This study is carried out to determine whether hospital volume can influence outcome in patients with NVUGIB.
  
  
  
  This is a retrospective study with a prospective cohort database (KCT 0000514. cris.nih.go.kr). Eight teaching hospitals were divided into two different groups: high-volume centers (HVC, ≥60 NVUGIB patients/year, four clinics) and low-volume centers (LVC, <60 NVUGIB patients/year, four clinics). Baseline characteristics of patients, risk stratification, and outcomes between hospitals of different volumes were compared. From February 2011 to December 2013, a total of 1584 NVUGIB patients enrolled in eight clinics were retrospectively reviewed. The main outcome measurements consisted of continuous bleeding after treatment, re-bleeding, necessity for surgical/other retreatments, and death within 30 days.
  
  
  
  Similar baseline characters for patients were observed in both groups. There was a significant difference in the incidence of poor outcome between the HVC and LVC groups (9.06 vs. 13.69%, P = 0.014). The incidence rate of poor outcome in high-risk patients (Rockall score ≥8) in HVC was lower than that in high-risk patients in LVC (16.07 vs. 26.92%, P = 0.048); however, there was no significant difference in poor outcome in the lower-risk patients in either group (8.72 vs. 10.42%, P = 0.370).
  
  
  
  Significant correlation between hospital volume and outcome in NVUGIB patients was observed. Referral to HVC for the management of high-risk NVUGIB patients should be considered in clinical practice.
authors.affiliation: Department of Internal Medicine, Kyungpook National University Medical Center, Daegu, Korea.|Kyungpook National University Hospital/School of Medicine, 807 Hoguk-ro, Buk-gu, Daegu, 41404, Korea.
authors.forename: Jin Woo
authors.initials: JW
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Kyungpook National University Medical Center, Daegu, Korea. sw-jeon@hanmail.net.|Kyungpook National University Hospital/School of Medicine, 807 Hoguk-ro, Buk-gu, Daegu, 41404, Korea. sw-jeon@hanmail.net.
authors.forename: Seong Woo
authors.initials: SW
authors.lastname: Jeon
authors.affiliation: Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Jung Gu
authors.initials: JG
authors.lastname: Kwon
authors.affiliation: Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea.
authors.forename: Chang Yoon
authors.initials: CY
authors.lastname: Ha
authors.affiliation: Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.
authors.forename: Kwang Bum
authors.initials: KB
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
authors.forename: Byung Ik
authors.initials: BI
authors.lastname: Jang
authors.affiliation: Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea.
authors.forename: Jung Bae
authors.initials: JB
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Soonchunhyang University Hospital, Gumi, Korea.
authors.forename: Youn Sun
authors.initials: YS
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004941:Esophagitis / Q000401:mortality* / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality* / Q000601:surgery; D016558:Hemostasis, Endoscopic / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Nonvariceal upper gastrointestinal bleeding; Outcomes; Prognosis; Volume of hospital