Scientific Reports (Oct 2021)
Outcomes in high and low volume hospitals in patients with acute hematochezia in a cohort study
- Naoki Ishii,
- Naoyoshi Nagata,
- Katsumasa Kobayashi,
- Atsushi Yamauchi,
- Atsuo Yamada,
- Jun Omori,
- Takashi Ikeya,
- Taiki Aoyama,
- Naoyuki Tominaga,
- Yoshinori Sato,
- Takaaki Kishino,
- Tsunaki Sawada,
- Masaki Murata,
- Akinari Takao,
- Kazuhiro Mizukami,
- Ken Kinjo,
- Shunji Fujimori,
- Takahiro Uotani,
- Minoru Fujita,
- Hiroki Sato,
- Sho Suzuki,
- Toshiaki Narasaka,
- Junnosuke Hayasaka,
- Tomohiro Funabiki,
- Yuzuru Kinjo,
- Akira Mizuki,
- Shu Kiyotoki,
- Tatsuya Mikami,
- Ryosuke Gushima,
- Hiroyuki Fujii,
- Yuta Fuyuno,
- Naohiko Gunji,
- Yosuke Toya,
- Kazuyuki Narimatsu,
- Noriaki Manabe,
- Koji Nagaike,
- Tetsu Kinjo,
- Yorinobu Sumida,
- Sadahiro Funakoshi,
- Kana Kawagishi,
- Tamotsu Matsuhashi,
- Yuga Komaki,
- Kuniko Miki,
- Kazuhiro Watanabe,
- Fumio Omata,
- Yasutoshi Shiratori,
- Noriatsu Imamura,
- Takahiko Yano,
- Mitsuru Kaise
Affiliations
- Naoki Ishii
- Division of Gastroenterology, Tokyo Shinagawa Hospital
- Naoyoshi Nagata
- Department of Gastroenterological Endoscopy, Tokyo Medical University
- Katsumasa Kobayashi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital
- Atsushi Yamauchi
- Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute
- Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
- Jun Omori
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine
- Takashi Ikeya
- Department of Gastroenterology, St. Luke’s International University
- Taiki Aoyama
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital
- Naoyuki Tominaga
- Department of Gastroenterology, Saga Medical Center Koseikan
- Yoshinori Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine
- Takaaki Kishino
- Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital
- Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital
- Masaki Murata
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center
- Akinari Takao
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
- Kazuhiro Mizukami
- Department of Gastroenterology, Oita University
- Ken Kinjo
- Department of Gastroenterology, Fukuoka University Chikushi Hospital
- Shunji Fujimori
- Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School
- Takahiro Uotani
- Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital
- Minoru Fujita
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center
- Hiroki Sato
- Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University
- Sho Suzuki
- Department of Gastroenterology and Hepatology, Center for Digestive Disease and Division of Endoscopy, University of Miyazaki Hospital
- Toshiaki Narasaka
- Department of Gastroenterology, University of Tsukuba
- Junnosuke Hayasaka
- Department of Gastroenterology, Toranomon Hospital
- Tomohiro Funabiki
- Department of Emergency Medicine, Fujita Health University Hospital
- Yuzuru Kinjo
- Department of Gastroenterology, Naha City Hospital
- Akira Mizuki
- Department of Internal Medicine, Tokyo Saiseikai Central Hospital
- Shu Kiyotoki
- Department of Gastroenterology, Shuto General Hospital
- Tatsuya Mikami
- Division of Endoscopy, Hirosaki University Hospital
- Ryosuke Gushima
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University
- Hiroyuki Fujii
- Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center
- Yuta Fuyuno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
- Naohiko Gunji
- Department of Gastroenterology, Fukushima Medical University
- Yosuke Toya
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University
- Kazuyuki Narimatsu
- Department of Internal Medicine, National Defense Medical College
- Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School
- Koji Nagaike
- Department of Gastroenterology and Hepatology, Suita Municipal Hospital
- Tetsu Kinjo
- Department of Endoscopy, University of the Ryukyus Hospital
- Yorinobu Sumida
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center
- Sadahiro Funakoshi
- Department of Gastroenterological Endoscopy, Fukuoka University Hospital
- Kana Kawagishi
- Department of Gastroenterology, School of Medicine, Kitasato University
- Tamotsu Matsuhashi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine
- Yuga Komaki
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences
- Kuniko Miki
- Department of Gastroenterological Endoscopy, Tokyo Medical University
- Kazuhiro Watanabe
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine
- Fumio Omata
- Division of Gastroenterology, Tokyo Shinagawa Hospital
- Yasutoshi Shiratori
- Division of Gastroenterology, Tokyo Shinagawa Hospital
- Noriatsu Imamura
- Division of Gastroenterology, Tokyo Shinagawa Hospital
- Takahiko Yano
- Division of Gastroenterology, Tokyo Shinagawa Hospital
- Mitsuru Kaise
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine
- DOI
- https://doi.org/10.1038/s41598-021-99832-6
- Journal volume & issue
-
Vol. 11,
no. 1
pp. 1 – 10
Abstract
Abstract Outcomes of acute lower gastrointestinal bleeding have not been compared according to hospital capacity. We aimed to perform a propensity score-matched cohort study with path and mediation analyses for acute hematochezia patients. Hospitals were divided into high- versus low-volume hospitals for emergency medical services. Rebleeding and death within 30 days were compared. Computed tomography, early colonoscopy (colonoscopy performed within 24 h), and endoscopic therapies were included as mediators. A total of 2644 matched pairs were yielded. The rebleeding rate within 30 days was not significant between high- and low-volume hospitals (16% vs. 17%, P = 0.44). The mortality rate within 30 days was significantly higher in the high-volume cohort than in the low-volume cohort (1.7% vs. 0.8%, P = 0.003). Treatment at high-volume hospitals was not a significant factor for rebleeding (odds ratio [OR] = 0.91; 95% confidence interval [CI], 0.79–1.06; P = 0.23), but was significant for death within 30 days (OR = 2.03; 95% CI, 1.17–3.52; P = 0.012) on multivariate logistic regression after adjusting for patients’ characteristics. Mediation effects were not observed, except for rebleeding within 30 days in high-volume hospitals through early colonoscopy. However, the direct effect of high-volume hospitals on rebleeding was not significant. High-volume hospitals did not improve the outcomes of acute hematochezia patients.
