BACKGROUND: In numerous high-risk medical and surgical conditions, a greater volume of patients undergoing treatment in a given setting or facility is associated with better survival. For patients with pulmonary embolism, the relation between the number of patients treated in a hospital (volume) and patient outcome is unknown. METHODS: We studied discharge records from 186 acute care hospitals in Pennsylvania for a total of 15 531 patients for whom the primary diagnosis was pulmonary embolism. The study outcomes were all-cause mortality in hospital and within 30 days after presentation for pulmonary embolism and the length of hospital stay. We used logistic models to study the association between hospital volume and 30-day mortality and discrete survival models to study the association between in-hospital mortality and time to hospital discharge. RESULTS: The median annual hospital volume for pulmonary embolism was 20 patients (interquartile range 10-42). Overall in-hospital mortality was 6.0%, whereas 30-day mortality was 9.3%. In multivariable analysis, very-high-volume hospitals (> or = 42 cases per year) had a significantly lower odds of in-hospital death (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.51-0.99) and of 30-day death (OR 0.71, 95% CI 0.54-0.92) than very-low-volume hospitals (< 10 cases per year). Although patients in the very-high-volume hospitals had a slightly longer length of stay than those in the very-low-volume hospitals (mean difference 0.7 days), there was no association between volume and length of stay. INTERPRETATION: In hospitals with a high volume of cases, pulmonary embolism was associated with lower short-term mortality. Further research is required to determine the causes of the relation between volume and outcome for patients with pulmonary embolism.
BACKGROUND: In numerous high-risk medical and surgical conditions, a greater volume of patients undergoing treatment in a given setting or facility is associated with better survival. For patients with pulmonary embolism, the relation between the number of patients treated in a hospital (volume) and patient outcome is unknown. METHODS: We studied discharge records from 186 acute care hospitals in Pennsylvania for a total of 15 531 patients for whom the primary diagnosis was pulmonary embolism. The study outcomes were all-cause mortality in hospital and within 30 days after presentation for pulmonary embolism and the length of hospital stay. We used logistic models to study the association between hospital volume and 30-day mortality and discrete survival models to study the association between in-hospital mortality and time to hospital discharge. RESULTS: The median annual hospital volume for pulmonary embolism was 20 patients (interquartile range 10-42). Overall in-hospital mortality was 6.0%, whereas 30-day mortality was 9.3%. In multivariable analysis, very-high-volume hospitals (> or = 42 cases per year) had a significantly lower odds of in-hospital death (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.51-0.99) and of 30-day death (OR 0.71, 95% CI 0.54-0.92) than very-low-volume hospitals (< 10 cases per year). Although patients in the very-high-volume hospitals had a slightly longer length of stay than those in the very-low-volume hospitals (mean difference 0.7 days), there was no association between volume and length of stay. INTERPRETATION: In hospitals with a high volume of cases, pulmonary embolism was associated with lower short-term mortality. Further research is required to determine the causes of the relation between volume and outcome for patients with pulmonary embolism.
Authors: Brian T Bateman; H Christian Schumacher; Bernadette Boden-Albala; Mitchell F Berman; J P Mohr; Ralph L Sacco; John Pile-Spellman Journal: Stroke Date: 2006-01-05 Impact factor: 7.914
Authors: Drahomir Aujesky; Pierre-Marie Roy; Cédric Petit Le Manach; Franck Verschuren; Guy Meyer; David Scott Obrosky; Roslyn A Stone; Jacques Cornuz; Michael J Fine Journal: Eur Heart J Date: 2005-10-05 Impact factor: 29.983
Authors: Jeremy M Kahn; Christopher H Goss; Patrick J Heagerty; Andrew A Kramer; Chelsea R O'Brien; Gordon D Rubenfeld Journal: N Engl J Med Date: 2006-07-06 Impact factor: 91.245
Authors: Peter K Lindenauer; Raj Behal; Cynthia K Murray; Wato Nsa; Peter M Houck; Dale W Bratzler Journal: Ann Intern Med Date: 2006-02-21 Impact factor: 25.391
Authors: Pierre-Marie Roy; Guy Meyer; Bruno Vielle; Catherine Le Gall; Franck Verschuren; Françoise Carpentier; Philippe Leveau; Alain Furber Journal: Ann Intern Med Date: 2006-02-07 Impact factor: 25.391
Authors: Karin Janata; Thomas Höchtl; Catharina Wenzel; Rudolf Jarai; Barbara Fellner; Alexander Geppert; Peter Smetana; Vera Havranek; Kurt Huber Journal: Clin Res Cardiol Date: 2011-12-22 Impact factor: 5.460