The Relationship between Hospital Volume and Mortality in Severe Sepsis.
Am J Respir Crit Care Med. 2014 Aug 12;
Authors: Gaieski DF, Edwards JM, Kallan MJ, Mikkelsen ME, Goyal M, Carr BG
Rationale: Severe sepsis is increasing in incidence and has a high rate of in-patient mortality. Hospitals that treat a larger number of patients with severe sepsis may offer a survival advantage. Objectives: We sought to assess the effect of severe sepsis case volume on mortality, hypothesizing that higher volume centers would have lower rates of inpatient death. Methods: We performed a retrospective cohort study over a 7-year period (2004-2010), utilizing a nationally representative sample of hospital admissions, examining the relation between volume, urban location, organ dysfunction and survival. Measurements: To identify potential differences in outcomes, hospitals were divided into 5 categories (<50, 50-99, 100-249, 250-499, 500+ annual cases) and adjusted mortality was compared by volume. Results: A total of 914,200 patients with severe sepsis were identified over a 7-year period (2004-2010). Overall in-hospital mortality was 28.1%. In a fully adjusted model, there was an inverse relationship between severe sepsis case volume and in-patient mortality. Hospitals in the highest volume category had substantially improved survival compared to hospitals with the lowest case volume [adjusted OR 0.64 (95% CI 0.60 - 0.69)]. In cases of severe sepsis with one reported organ dysfunction, a mortality of 18.9% was found in hospitals with < 50 annual cases compared to 10.4% in hospitals treating 500+ cases [adjusted OR 0.54 (95% CI 0.49-0.59)]. Similar differences were found in patients with up to three total organ dysfunctions. Conclusions: Patients with severe sepsis treated in hospitals with higher case volumes had improved adjusted outcomes.
PMID: 25117723 [PubMed - as supplied by publisher]