Akira Endo1, Atsushi Shiraishi1,2, Kiyohide Fushimi3, Kiyoshi Murata1,4, Yasuhiro Otomo1. 1. Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan. 2. Emergency and Trauma Center, Kameda Medical Center, Chiba, Japan. 3. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan. 4. The Shock Trauma and Emergency Medical Center, Matsudo City Hospital, Chiba, Japan.
Abstract
OBJECTIVE: The aim of this study was to evaluate the associations of severe trauma patient volume with survival benefit and health care costs. BACKGROUND: The effect of trauma patient volume on survival benefit is inconclusive, and reports on its effects on health care costs are scarce. METHODS: We conducted a retrospective observational study, including trauma patients who were transferred to government-approved tertiary emergency hospitals, or hospitals with an intensive care unit that provided an equivalent quality of care, using a Japanese nationwide administrative database. We categorized hospitals according to their annual severe trauma patient volumes [1 to 50 (reference), 51 to 100, 101 to 150, 151 to 200, and ≥201]. We evaluated the associations of volume categories with in-hospital survival and total cost per admission using a mixed-effects model adjusting for patient severity and hospital characteristics. RESULTS: A total of 116,329 patients from 559 hospitals were analyzed. Significantly increased in-hospital survival rates were observed in the second, third, fourth, and highest volume categories compared with the reference category [94.2% in the highest volume category vs 88.8% in the reference category, adjusted odds ratio (95% confidence interval, 95% CI) = 1.75 (1.49-2.07)]. Furthermore, significantly lower costs (in US dollars) were observed in the second and fourth categories [mean (standard deviation) for fourth vs reference = $17,800 ($17,378) vs $20,540 ($32,412), adjusted difference (95% CI) = -$2559 (-$3896 to -$1221)]. CONCLUSIONS: Hospitals with high volumes of severe trauma patients were significantly associated with a survival benefit and lower total cost per admission.
OBJECTIVE: The aim of this study was to evaluate the associations of severe traumapatient volume with survival benefit and health care costs. BACKGROUND: The effect of traumapatient volume on survival benefit is inconclusive, and reports on its effects on health care costs are scarce. METHODS: We conducted a retrospective observational study, including traumapatients who were transferred to government-approved tertiary emergency hospitals, or hospitals with an intensive care unit that provided an equivalent quality of care, using a Japanese nationwide administrative database. We categorized hospitals according to their annual severe traumapatient volumes [1 to 50 (reference), 51 to 100, 101 to 150, 151 to 200, and ≥201]. We evaluated the associations of volume categories with in-hospital survival and total cost per admission using a mixed-effects model adjusting for patient severity and hospital characteristics. RESULTS: A total of 116,329 patients from 559 hospitals were analyzed. Significantly increased in-hospital survival rates were observed in the second, third, fourth, and highest volume categories compared with the reference category [94.2% in the highest volume category vs 88.8% in the reference category, adjusted odds ratio (95% confidence interval, 95% CI) = 1.75 (1.49-2.07)]. Furthermore, significantly lower costs (in US dollars) were observed in the second and fourth categories [mean (standard deviation) for fourth vs reference = $17,800 ($17,378) vs $20,540 ($32,412), adjusted difference (95% CI) = -$2559 (-$3896 to -$1221)]. CONCLUSIONS: Hospitals with high volumes of severe traumapatients were significantly associated with a survival benefit and lower total cost per admission.