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Volume-Mortality Relationships during Hospitalization with Severe Sepsis Exist Only at Low Case Volumes.
Ann Am Thorac Soc. 2015 Jun 18;
Authors: Goodwin AJ, Simpson KN, Ford DW
Abstract
RATIONALE: Volume-outcome associations have been demonstrated in conditions with high morbidity and mortality, however, the existing literature regarding such associations in sepsis is not definitive.
OBJECTIVE: To test the hypothesis that annual hospital severe sepsis case volume is associated with mortality during admissions with severe sepsis in both teaching and non-teaching hospitals.
METHODS: Retrospective cohort study of administrative data from the South Carolina State Inpatient Database using multivariate logistic regression and case mix adjustment.
MEASUREMENTS AND MAIN RESULTS: In the calendar year 2010, 9815 patients were admitted with severe sepsis or septic shock. Hospitals were stratified into low (0-75 cases/year, N = 26), intermediate (76-300 cases/year, N = 19) and high (>300 cases/year, N = 12) volume tertiles. Patients admitted to hospitals with a low annual case volume for sepsis had higher adjusted odds of dying before discharge (OR 1.56, 1.25-1.94) compared to patients admitted to high volume hospitals. Hospitalization at intermediate volume hospitals was not associated with a difference in mortality (OR 0.99, 0.90-1.09) compared to high volume hospitals. There was no difference between the mortality rates of intermediate and high volume hospitals at different severity of illness quartiles. Hospital length of stay differed significantly by hospital case volume (low = 8.0, intermediate = 12.7, high = 14.9 [days], p<0.0001).
CONCLUSIONS: Hospitals with low annual sepsis case volume are associated with higher mortality rates while hospitals with intermediate sepsis case volumes are associated with similar mortality rates compared to hospitals with high case volumes.
PMID: 26086787 [PubMed - as supplied by publisher]