Hospital volume and mortality for mechanical ventilation of medical and surgical patients: A population-based analysis using administrative data

Dale Needham, Susan E. Bronskill, Deanna M. Rothwell, William J. Sibbald, Peter J. Pronovost, Andreas Laupacis, Thérèse A. Stukel

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: In an effort to improve efficiency and quality of care, regionalization of adult critical care services, similar to trauma and neonatal intensive care, has been suggested. However, there is little research to understand if hospitals with higher patient volumes have better outcomes. Our objective is to determine whether hospital volume is associated with improved survival for medical or surgical patients receiving mechanical ventilation. DESIGN: Population-based retrospective cohort study. SETTING: Province of Ontario, Canada. PATIENTS: A total of 13,846 medical and 6,373 surgical patients receiving mechanical ventilation for greater than two consecutive days between 1998 and 2000. INTERVENTIONS: None. MEASUREMENTS: Odds ratio for death within 30 days of initiation of mechanical ventilation was calculated in relation to hospital volume of ventilation. Estimates were adjusted for patient demographics, diagnoses, and urgency status; hospital region and rural location; and accounted for clustering within hospitals. MAIN RESULTS: There was no effect of volume on mortality for surgical patients. After adjustment for clustering, among medical patients, the lowest-volume category (2 days, hospital volume had no effect on mortality. For medical patients, higher mortality may occur in a subgroup of low-volume hospitals that do not routinely transfer their patients to larger-volume facilities. This finding needs further investigation in a larger-sized study.

Original languageEnglish (US)
Pages (from-to)2349-2354
Number of pages6
JournalCritical Care Medicine
Volume34
Issue number9
DOIs
StatePublished - Sep 2006

Fingerprint

Hospital Mortality
Artificial Respiration
Population
Cluster Analysis
Mortality
Low-Volume Hospitals
Neonatal Intensive Care
Patient Transfer
Rural Hospitals
Quality of Health Care
Ontario
Critical Care
Canada
Ventilation
Cohort Studies
Retrospective Studies
Odds Ratio
Demography
Survival
Wounds and Injuries

Keywords

  • Case volume
  • Critical care
  • Critical illness
  • Health policy
  • Health services research
  • Intensive care units
  • Mechanical ventilation
  • Outcome assessment

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Hospital volume and mortality for mechanical ventilation of medical and surgical patients : A population-based analysis using administrative data. / Needham, Dale; Bronskill, Susan E.; Rothwell, Deanna M.; Sibbald, William J.; Pronovost, Peter J.; Laupacis, Andreas; Stukel, Thérèse A.

In: Critical Care Medicine, Vol. 34, No. 9, 09.2006, p. 2349-2354.

Research output: Contribution to journalArticle

Needham, Dale ; Bronskill, Susan E. ; Rothwell, Deanna M. ; Sibbald, William J. ; Pronovost, Peter J. ; Laupacis, Andreas ; Stukel, Thérèse A. / Hospital volume and mortality for mechanical ventilation of medical and surgical patients : A population-based analysis using administrative data. In: Critical Care Medicine. 2006 ; Vol. 34, No. 9. pp. 2349-2354.
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