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Effect of Institutional Case Volume on In-Hospital and Long-Term Mortality in Critically Ill Patients Requiring Mechanical Ventilation for 48 Hours or More

Journal of Korean Medical Science 2019년 34권 34호 p.212 ~ 212
 ( Lee Han-Nah ) - Seoul National University College of Medicine Seoul National University Hospital Department of Anesthesiology and Pain Medicine

 ( Choi Seong-Mi ) - National Health Insurance Service Health Insurance Policy Research Institute
 ( Jang Eun-Jin ) - Andong National University Department of Information Statistics
 ( Lee Ju-Hee ) - Kyungpook National University College of Natural Sciences Department of Statistics
 ( Kim Dal-Ho ) - Kyungpook National University College of Natural Sciences Department of Statistics
 ( Yoo Seok-Ha ) - Seoul National University College of Medicine Seoul National University Hospital Department of Anesthesiology and Pain Medicine
 ( Oh Seung-Young ) - Seoul National University College of Medicine Seoul National University Hospital Department of Surgery
 ( Ryu Ho-Geol ) - Seoul National University College of Medicine Seoul National University Hospital Department of Anesthesiology and Pain Medicine

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.

키워드

Mortality; Case Volume; Mechanical Ventilation
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