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PLoS One. 2014 Sep 29;9(9):e108754. doi: 10.1371/journal.pone.0108754. eCollection 2014.

The effect of hospital volume on mortality in patients admitted with severe sepsis.

Author information

1
Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America.
2
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America.
3
Clinical Research Centre, Soroka University Medical Centre and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
4
Washington and Lee University, Lexington, Virginia, United States of America.

Abstract

IMPORTANCE:

The association between hospital volume and inpatient mortality for severe sepsis is unclear.

OBJECTIVE:

To assess the effect of severe sepsis case volume and inpatient mortality.

DESIGN SETTING AND PARTICIPANTS:

Retrospective cohort study from 646,988 patient discharges with severe sepsis from 3,487 hospitals in the Nationwide Inpatient Sample from 2002 to 2011.

EXPOSURES:

The exposure of interest was the mean yearly sepsis case volume per hospital divided into tertiles.

MAIN OUTCOMES AND MEASURES:

Inpatient mortality.

RESULTS:

Compared with the highest tertile of severe sepsis volume (>60 cases per year), the odds ratio for inpatient mortality among persons admitted to hospitals in the lowest tertile (≤10 severe sepsis cases per year) was 1.188 (95% CI: 1.074-1.315), while the odds ratio was 1.090 (95% CI: 1.031-1.152) for patients admitted to hospitals in the middle tertile. Similarly, improved survival was seen across the tertiles with an adjusted inpatient mortality incidence of 35.81 (95% CI: 33.64-38.03) for hospitals with the lowest volume of severe sepsis cases and a drop to 32.07 (95% CI: 31.51-32.64) for hospitals with the highest volume.

CONCLUSIONS AND RELEVANCE:

We demonstrate an association between a higher severe sepsis case volume and decreased mortality. The need for a systems-based approach for improved outcomes may require a high volume of severely septic patients.

PMID:
25264788
PMCID:
PMC4181313
DOI:
10.1371/journal.pone.0108754
[Indexed for MEDLINE]
Free PMC Article

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