J Korean Med Sci.
2019 Sep;34(34):e212. 10.3346/jkms.2019.34.e212.
Effect of Institutional Case Volume on In-Hospital and Long-Term Mortality in Critically Ill Patients Requiring Mechanical Ventilation for 48 Hours or More
- Affiliations
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- 1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. hogeol@gmail.com
- 2Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Korea.
- 3Department of Information Statistics, Andong National University, Andong, Korea.
- 4Department of Statistics, College of Natural Sciences, Kyungpook National University, Daegu, Korea.
- 5Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
- KMID: 2455779
- DOI: http://doi.org/10.3346/jkms.2019.34.e212
Abstract
- BACKGROUND
The purpose of this study was to evaluate whether institutional case volume affects clinical outcomes in patients receiving mechanical ventilation for 48 hours or more.
METHODS
We conducted a nationwide retrospective cohort study using the database of Korean National Healthcare Insurance Service. Between January 2007 and December 2016, 158,712 adult patients were included at 55 centers in Korea. Centers were categorized according to the average annual number of patients: > 500, 500 to 300, and < 300.
RESULTS
In-hospital mortality rates in the high-, medium-, and low-volume centers were 32.6%, 35.1%, and 39.2%, respectively. After adjustment, in-hospital mortality was significantly higher in low-volume centers (adjusted odds ratio [OR], 1.332; 95% confidence interval [CI], 1.296-1.368; P < 0.001) and medium-volume centers (adjusted OR, 1.125; 95% CI, 1.098-1.153; P < 0.001) compared to high-volume centers. Long-term survival for up to 8 years was better in high-volume centers.
CONCLUSION
Centers with higher case volume (> 500 patients/year) showed lower in-hospital mortality and long-term mortality, compared to centers with lower case volume (< 300 patients/year) in patients who required mechanical ventilation for 48 hours or more.
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