Volume-outcome relationships for tracheostomies in Australia and New Zealand Intensive Care Units: A registry-based retrospective study

被引：0
作者：
Marella, Prashanti [1 ,2 ]
Ramanan, Mahesh [1 ,3 ,4 ]
Tabah, Alexis [2 ,3 ,5 ]
Litton, Ed [6 ,7 ]
Edwards, Felicity [3 ]
Laupland, Kevin B. [3 ,8 ]
机构：
[1] Caboolture Hosp, Metro North Hosp & Hlth Serv, Dept Intens Care Med, Brisbane, Australia
[2] Univ Queensland, Fac Med, Brisbane, Australia
[3] Queensland Univ Technol, Brisbane, Australia
[4] Univ New South Wales, George Inst Global Hlth, Crit Care Div, Sydney, Australia
[5] Redcliffe Hosp, Metro North Hosp & Hlth Serv, Intens Care Unit, Brisbane, Australia
[6] Fiona Stanley Hosp, Intens Care Unit, Murdoch, WA, Australia
[7] Univ Western Australia, Sch Med, Crawley, WA 6009, Australia
[8] Royal Brisbane Womens Hosp, Metro North Hosp & Hlth Serv, Dept Intens Care Med, Brisbane, Australia
来源：
CRITICAL CARE AND RESUSCITATION | 2025年 / 27卷 / 01期
关键词：
Tracheostomy; Intensivist; Volume-outcome; Intensive care unit; Case fatality; CRITICALLY-ILL PATIENTS; RECEIVING MECHANICAL VENTILATION; IMPACT; MORTALITY;
D O I：
10.1016/j.ccrj.2024.12.002
中图分类号：
R4 [临床医学];
学科分类号：
1002 ; 100602 ;
摘要：
Objective: It is unknown whether a volume-outcome relationship exists for patients who receive tracheostomy in the intensive care unit (ICU) as has been observed in other healthcare settings. This study aimed to determine the average number of tracheostomies performed per intensivist per ICU in Australia and New Zealand and associations with case fatality. Design: A retrospective cohort study of adult ICU admissions was conducted. Setting: Data from the Australia and New Zealand Intensive Care Society Adult Patient Database and Critical care resources registry were linked and analysed over the time period extending from 01 January 2018 to 31 March 2023. Participants: The study population included adults (aged >= 18 years) admitted to Australia and New Zealand ICUs who received tracheostomy. Intervention: No intervention was reported. Main outcome measures: The primary exposure variable was tracheostomies per intensivist (TPIs), which was calculated as (the number of patients who had tracheostomy inserted during their ICU admission)/(the total number of intensivists), for each site for each financial year. Results: There were 9318 patients from 172 ICUs over a 5-year period, from January 2018 to March 2023, who received tracheostomies and were included in this analysis. The median TPI value was 3.1 (interquartile range: 1.9-4.3). Raw case fatality in the total cohort was 13.7% (1280/9318). The lowest adjusted risk of death (8.5%, 95% confidence interval: 3.63%-13.36%) was observed when the TPI value was equal to 10.3, with higher risk of death observed at lower values of TPI. Conclusions: A volume-outcome relationship was observed between TPI value and hospital case fatality, with lower case fatality at higher TPI values across the entire range of TPI. (c) 2025 The Authors. Published by Elsevier B.V. on behalf of College of Intensive Care Medicine of Australia and New Zealand. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
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  • [1] Li T.C., Phillips M.C., Shaw L., Cook E.F., Natanson C., Goldman L., On-site physician staffing in a 1-community hospital intensive care unit. Impact on test and procedure use and on patient outcome, JAMA, 252, pp. 2023-2027, (1984)
  • [2] Pollack M.M., Katz R.W., Ruttimann U.E., Improving the outcome and efficiency of intensive care: the impact of an intensivist, Crit Care Med, 16, pp. 11-17, (1988)
  • [3] Pronovost P.J., Angus D.C., Dorman T., Robinson K.A., Dremsizov T.T., Young T.L., Et al., Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review, JAMA, 288, pp. 2151-2162, (2002)
  • [4] Pronovost P.J., Jenckes M.W., Dorman T., Garrett E., Brestow M.J., Rosenfeld B.A., Et al., Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery, JAMA, 281, pp. 1310-1317, (1999)
  • [5] Treggiari M.M., Martin D.P., Yanez N.D., Caldwell E., Hudson L.D., Rubenfeld G.D., Effect of intensive care unit organizational model and structure on outcomes in patients with acute lung injury, Am J Respir Crit Care Med, 176, pp. 685-690, (2007)
  • [6] Levaillant M., Marcilly R., Levaillant L., Vallet B., Lameret A., Assessing the hospital volume-outcome relationship in surgery: a scoping review protocol, BMJ Open, 10, (2020)
  • [7] El Amrani M., Clement G., Lenne X., Rogosnitzky M., Theis D., Pruvot F.R., Et al., The impact of hospital volume and charlson score on postoperative mortality of proctectomy for rectal cancer: a nationwide study of 45,569 patients, Ann Surg, 268, 5, pp. 854-860, (2018)
  • [8] El Amrani M., Clement G., Lenne X., Farges O., Delpero J.R., Theise D., Et al., Failure-to-rescue in patients undergoing pancreatectomy: is hospital volume a standard for quality improvement programs? Nationwide analysis of 12,333 patients, Ann Surg, 268, 5, pp. 799-807, (2018)
  • [9] Pasquer A., Renaud F., Hec F., Gandon A., Vanderbeken M., Drubayet V., Et al., Is centralization needed for esophageal and gastric cancer patients with low operative risk?, Ann Surg, 264, 5, pp. 823-830, (2016)
  • [10] Morche J., Mathes T., Pieper D., Relationship between surgeon volume and outcomes: a systematic review of systematic reviews, Syst Rev, 5, pp. 1-15, (2016)
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