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Hospital Volume and Mortality for Mechanically Ventilated Patients

An analysis of data from a large group of hospitals suggests a relation between hospital volume and quality of care for such patients.

For some surgical and medical conditions, outcomes are better in hospitals that treat large numbers of patients with that specific condition. To determine whether outcomes for patients requiring mechanical ventilation are better in high-volume than in low-volume hospitals, researchers used a database containing information gathered prospectively from intensive care units (ICUs) in a large group of U.S. hospitals.

The analysis was based on data for 20,241 patients who received mechanical ventilation in 37 hospitals in 2002–2003. After adjustment for severity of illness, demographic variables, and characteristics of the ICUs (including staffing by intensivists), higher ICU volume was significantly associated with lower ICU and hospital mortality rates. For example, adjusted ICU mortality (for a patient at average predicted risk for ICU death) was 21.2% in hospitals with 87 to 150 mechanically ventilated patients annually, and 14.5% in hospitals with 401 to 617 mechanically ventilated patients annually. Hospitals with intermediate numbers of patients had outcomes between these extremes.

Comment: These results strongly suggest a relation between hospital volume and quality of care for mechanically ventilated patients. The next step is to determine which elements of ICU care are responsible for this volume-mortality association. The findings also suggest that regionalized ICU care might improve outcomes for high-risk patients. That possibility is supported by another study, published in Critical Care Medicine, in which mortality rates were lower among high-risk ICU patients who were treated in ICUs that had large volumes of high-risk patients.

— Allan S. Brett, MD

Published in Journal Watch General Medicine August 1, 2006

Citation(s):

Kahn JM et al. Hospital volume and the outcomes of mechanical ventilation. N Engl J Med 2006 Jul 6; 355:41-50.

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