FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 355:41-50 July 6, 2006 Number 1 Next

	Full Text PDF PDA Full Text Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background An increased volume of patients is associated with improved survival in numerous high-risk medical and surgical conditions. The relationship between the number of patients admitted (hospital volume) and outcome among patients with critical illnesses is unknown.

Methods We analyzed data from 20,241 nonsurgical patients receiving mechanical ventilation at 37 acute care hospitals in the Acute Physiology and Chronic Health Evaluation clinical information system from 2002 through 2003. Multivariate analyses were performed to adjust for the severity of illness and other differences in the case mix.

Results An increase in hospital volume was associated with improved survival among patients receiving mechanical ventilation in the intensive care unit (ICU) and in the hospital. Admission to a hospital in the highest quartile according to volume (i.e., >400 patients receiving mechanical ventilation per year) was associated with a 37 percent reduction in the adjusted odds of death in the ICU as compared with admission to hospitals in the lowest quartile (150 patients receiving mechanical ventilation per year, P<0.001). In-hospital mortality was similarly reduced (adjusted odds ratio, 0.66; 95 percent confidence interval, 0.52 to 0.83; P<0.001). A typical patient in a hospital in a low-volume quartile would have an adjusted in-hospital mortality of 34.2 percent as compared with 25.5 percent in a hospital in a high-volume quartile. Among survivors, there were no significant trends in the length of stay in the ICU or the hospital.

Conclusions Mechanical ventilation of patients in a hospital with a high case volume is associated with reduced mortality. Further research is needed to determine the mechanism of the relationship between volume and outcome among patients with a critical illness.

Source Information

From the Division of Pulmonary and Critical Care Medicine (J.M.K., C.H.G., C.R.O., G.D.R.) and the Department of Biostatistics (P.J.H.), University of Washington, Seattle; and the Cerner Corporation, Kansas City, Mo. (A.A.K.).

Address reprint requests to Dr. Rubenfeld at Harborview Medical Center, University of Washington, Box 359762, 325 Ninth Ave., Seattle, WA 98104, or at nodrog{at}u.washington.edu.

Full Text of this Article

Related Letters:

Hospital Volume and Outcomes of Mechanical Ventilation
Hughes-Davies T., Arah O. A., Kahn J. M., Rubenfeld G. D.
Extract | Full Text | PDF  
N Engl J Med 2006; 355:1617-1619, Oct 12, 2006. Correspondence

This article has been cited by other articles:

• Zilberberg, M. D., Kramer, A. A., Higgins, T. L., Shorr, A. F. (2009). Prolonged Acute Mechanical Ventilation: Implications for Hospital Benchmarking. Chest 135: 1157-1162 [Abstract] [Full Text]  
• Lott, J. P., Iwashyna, T. J., Christie, J. D., Asch, D. A., Kramer, A. A., Kahn, J. M. (2009). Critical Illness Outcomes in Specialty versus General Intensive Care Units. Am. J. Respir. Crit. Care Med. 179: 676-683 [Abstract] [Full Text]  
• Iwashyna, T. J., Christie, J. D., Kahn, J. M., Asch, D. A. (2009). Uncharted Paths: Hospital Networks in Critical Care. Chest 135: 827-833 [Abstract] [Full Text]  
• Kramer, A. A., Zimmerman, J. E. (2008). Predicting Outcomes for Cardiac Surgery Patients After Intensive Care Unit Admission. SEMIN CARDIOTHORAC VASC ANESTH 12: 175-183 [Abstract]  
• Lecuyer, L., Chevret, S., Guidet, B., Aegerter, P., Martel, P., Schlemmer, B., Azoulay, E. (2008). Case volume and mortality in haematological patients with acute respiratory failure. Eur Respir J 32: 748-754 [Abstract] [Full Text]  
• Lin, H.-C., Xirasagar, S., Chen, C.-H., Hwang, Y.-T. (2008). Physician's Case Volume of Intensive Care Unit Pneumonia Admissions and In-Hospital Mortality. Am. J. Respir. Crit. Care Med. 177: 989-994 [Abstract] [Full Text]  
• Williams, S. C., Koss, R. G., Morton, D. J., Schmaltz, S. P., Loeb, J. M. (2008). Case volume and hospital compliance with evidence-based processes of care. Int J Qual Health Care 20: 79-87 [Abstract] [Full Text]  
• Kahn, J. M., Linde-Zwirble, W. T., Wunsch, H., Barnato, A. E., Iwashyna, T. J., Roberts, M. S., Lave, J. R., Angus, D. C. (2008). Potential Value of Regionalized Intensive Care for Mechanically Ventilated Medical Patients. Am. J. Respir. Crit. Care Med. 177: 285-291 [Abstract] [Full Text]  
• Aujesky, D. MD MSc, Mor, M. K. PhD, Geng, M. MS, Fine, M. J. MD MSc, Renaud, B. MD, Ibrahim, S. A. MD MPH (2008). Hospital volume and patient outcomes in pulmonary embolism. CMAJ 178: 27-33 [Abstract] [Full Text]  
• Carrier, M. MD, Wells, P. S. MD MSc (2008). Should we regionalize the management of pulmonary embolism?. CMAJ 178: 58-60 [Full Text]  
• Treggiari, M. M., Martin, D. P., Yanez, N. D., Caldwell, E., Hudson, L. D., Rubenfeld, G. D. (2007). Effect of Intensive Care Unit Organizational Model and Structure on Outcomes in Patients with Acute Lung Injury. Am. J. Respir. Crit. Care Med. 176: 685-690 [Abstract] [Full Text]  
• Jones, N. E., Suurdt, J., Ouelette-Kuntz, H., Heyland, D. K. (2007). Implementation of the Canadian Clinical Practice Guidelines for Nutrition Support: A Multiple Case Study of Barriers and Enablers. Nutr Clin Pract 22: 449-457 [Abstract] [Full Text]  
• Rubenfeld, G. D., McNamara-Aslin, E., Rubinson, L. (2007). The Pulmonary Artery Catheter, 1967 2007: Rest in Peace?. JAMA 298: 458-461 [Full Text]  
• Turchin, A., Shubina, M., Pendergrass, M. L. (2007). Relationship of Physician Volume With Process Measures and Outcomes in Diabetes. Diabetes Care 30: 1442-1447 [Abstract] [Full Text]  
• Phibbs, C. S., Baker, L. C., Caughey, A. B., Danielsen, B., Schmitt, S. K., Phibbs, R. H. (2007). Level and Volume of Neonatal Intensive Care and Mortality in Very-Low-Birth-Weight Infants. NEJM 356: 2165-2175 [Abstract] [Full Text]  
• Milbrandt, E. B., Ishizaka, A., Angus, D. C. (2007). Update in Critical Care 2006. Am. J. Respir. Crit. Care Med. 175: 638-648 [Full Text]  
• Hughes-Davies, T., Arah, O. A., Kahn, J. M., Rubenfeld, G. D. (2006). Hospital volume and outcomes of mechanical ventilation.. NEJM 355: 1617-1617 [Full Text]  
• Bryan-Brown, C. W., Dracup, K. (2006). The whole truth.. Am J Crit Care 15: 448-450 [Full Text]  
• (2006). Hospital Volume and Mortality for Mechanically Ventilated Patients. JWatch General 2006: 1-1 [Full Text]