Procedure volume is one determinant of centre effect in mechanically ventilated patients

被引:13
作者
Darmon, M. [1 ,2 ,7 ,8 ]
Azoulay, E. [2 ,6 ]
Fulgencio, J-P. [5 ]
Garrigues, B. [9 ]
Gouzes, C. [10 ]
Moine, P. [12 ]
Villers, D. [11 ]
Teboul, V. [2 ]
le Gall, J.-R. [2 ,6 ]
Chevret, S. [3 ,4 ,6 ]
机构
[1] St Etienne Univ Hosp, Med Surg Intens Care Unit, Thrombosis Res Grp, EA 3065, F-42270 St Etienne, France
[2] St Louis Univ Hosp, Med Intens Care Unit, Paris, France
[3] St Louis Univ Hosp, Dept Biostat, Paris, France
[4] St Louis Univ Hosp, INSERM, UMRS 717, Paris, France
[5] Tenon Univ Hosp, AP HP, Surg Intens Care Unit, Paris, France
[6] Univ Paris 07, Paris, France
[7] St Etienne Med Sch, St Etienne, France
[8] St Etienne Univ Hosp, Med Intens Care Unit, F-42270 St Etienne, France
[9] Pays DAix Hosp, Med Surg Intens Care Unit, Aix En Provence, France
[10] Ales Hosp, Med Intens Care Unit, Ales, France
[11] Nantes Hotel Dieu Univ Hosp, Med Surg Intens Care Unit, Nantes, France
[12] Univ Colorado, Hlth Sci Ctr, Dept Anesthesiol, Denver, CO USA
关键词
Acute respiratory distress syndrome; databases; factual; intensive care unit; outcome assessment; performance; quality of healthcare; INTENSIVE-CARE-UNIT; HOSPITAL VOLUME; ADMINISTRATIVE DATA; OUTCOME RELATIONSHIPS; MORTALITY; IMPACT; SURGERY; ASSOCIATION; CALIFORNIA; SERVICES;
D O I
10.1183/09031936.00195209
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Survival rates vary significantly between intensive care units, most notably in patients requiring mechanical ventilation (MV). The present study sought to estimate the effect of hospital MV volume on hospital mortality. We included 179,197 consecutive patients who received mechanical ventilation in 294 hospitals. Multivariate logistic regression models with random intercepts were used to estimate the effect of annual MV volume in each hospital, adjusting for differences in severity of illness and case mix. Median annual MV volume was 162 patients (interquartile range 99-282). Hospital mortality in MV patients was 31.4% overall, 40.8% in the lowest annual volume quartile and 28.2% in the highest quartile. After adjustment for severity of illness, age, diagnosis and organ failure, higher MV volume was associated with significantly lower hospital mortality among MV patients (OR 0.9985 per 10 additional patients, 95% CI 0.9978-0.9992; p=0.0001). A significant centre effect on hospital mortality persisted after adjustment for volume effect (p<0.0001). Our study demonstrated higher hospital MV volume to be independently associated with increased survival among MV patients. Significant differences in outcomes persisted between centres after adjustment for hospital MV volume, supporting a role for other significant determinants of the centre effect.
引用
收藏
页码:364 / 370
页数:7
相关论文
共 32 条
[1]   Critical care delivery in the United States: Distribution of services and compliance with Leapfrog recommendations [J].
Angus, DC ;
Shorr, AF ;
White, A ;
Dremsizov, TT ;
Schmitz, RJ ;
Kelley, MA .
CRITICAL CARE MEDICINE, 2006, 34 (04) :1016-1024
[2]   Impact of hospital volume on operative mortality for major cancer surgery [J].
Begg, CB ;
Cramer, LD ;
Hoskins, WJ ;
Brennan, MF .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1998, 280 (20) :1747-1751
[3]   Hospital volume and surgical mortality in the United States. [J].
Birkmeyer, JD ;
Siewers, AE ;
Finlayson, EVA ;
Stukel, TA ;
Lucas, FL ;
Batista, I ;
Welch, HG ;
Wennberg, DE .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 346 (15) :1128-1137
[4]   Critical care delivery in the intensive care unit: Defining clinical roles and the best practice model [J].
Brilli, RJ ;
Spevetz, A ;
Branson, RD ;
Campbell, GM ;
Cohen, H ;
Dasta, JF ;
Harvey, MA ;
Kelley, MA ;
Kelly, KM ;
Rudis, MI ;
St Andre, AC ;
Stone, JR ;
Teres, D ;
Weled, BJ .
CRITICAL CARE MEDICINE, 2001, 29 (10) :2007-2019
[5]   EFFECT ON ICU MORTALITY OF A FULL-TIME CRITICAL CARE SPECIALIST [J].
BROWN, JJ ;
SULLIVAN, G .
CHEST, 1989, 96 (01) :127-129
[6]   Effects of organizational change in the medical intensive care unit of a teaching hospital - A comparison of 'open' and 'closed' formats [J].
Carson, SS ;
Stocking, C ;
Podsadecki, T ;
Christenson, J ;
Pohlman, A ;
MacRae, S ;
Jordan, J ;
Humphrey, H ;
Siegler, M ;
Hall, J .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1996, 276 (04) :322-328
[7]   Initial presentation of older injured patients to high-volume hospitals is not associated with lower 30-day mortality in Medicare data [J].
Clark, David E. ;
DeLorenzo, Michael A. ;
Lucas, F. L. ;
Cushing, Brad M. .
CRITICAL CARE MEDICINE, 2007, 35 (08) :1829-1836
[8]   Identifying priorities in methodological research using ICD-9-ICM and ICD-10 administrative data: report from an international consortium [J].
De Coster, Carolyn ;
Quan, Hude ;
Finlayson, Alan ;
Gao, Min ;
Halfon, Patricia ;
Humphries, Karin H. ;
Johansen, Helen ;
Lix, Lisa M. ;
Luthi, Jean-Christophe ;
Ma, Jin ;
Romano, Patrick S. ;
Roos, Leslie ;
Sundararajan, Vijaya ;
Tu, Jack V. ;
Webster, Greg ;
Ghali, William A. .
BMC HEALTH SERVICES RESEARCH, 2006, 6 (1)
[9]   Hospital volume-outcome relationships among medical admissions to ICUs [J].
Durairaj, L ;
Torner, JC ;
Chrischilles, EA ;
Sarrazin, MSV ;
Yankey, J ;
Rosenthal, GE .
CHEST, 2005, 128 (03) :1682-1689
[10]   Evolution of mechanical ventilation in response to clinical research [J].
Esteban, Andres ;
Ferguson, Niall D. ;
Meade, Maureen O. ;
Frutos-Vivar, Fernando ;
Apezteguia, Carlos ;
Brochard, Laurent ;
Raymondos, Konstantinos ;
Nin, Nicolas ;
Hurtado, Javier ;
Tomicic, Vinko ;
Gonzalez, Marco ;
Elizalde, Jose ;
Nightingale, Peter ;
Abroug, Fekri ;
Pelosi, Paolo ;
Arabi, Yaseen ;
Moreno, Rui ;
Jibaja, Manuel ;
D'Empaire, Gabriel ;
Sandi, Fredi ;
Matamis, Dimitros ;
Montanez, Ana Maria ;
Anzueto, Antonio .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2008, 177 (02) :170-177