Hospital volume and mortality for mechanical ventilation of medical and surgical patients: A population-based analysis using administrative data*

Abstract

In an effort to improve efficiency and quality of care, regionalization of adult critical care services, similar to trauma and neonatal intensive care, has been suggested. However, there is little research to understand if hospitals with higher patient volumes have better outcomes. Our objective is to determine whether hospital volume is associated with improved survival for medical or surgical patients receiving mechanical ventilation. Population-based retrospective cohort study. Province of Ontario, Canada. A total of 13,846 medical and 6,373 surgical patients receiving mechanical ventilation for greater than two consecutive days between 1998 and 2000. None. Odds ratio for death within 30 days of initiation of mechanical ventilation was calculated in relation to hospital volume of ventilation. Estimates were adjusted for patient demographics, diagnoses, and urgency status; hospital region and rural location; and accounted for clustering within hospitals. There was no effect of volume on mortality for surgical patients. After adjustment for clustering, among medical patients, the lowest-volume category (Conclusions: For surgical patients requiring mechanical ventilation for >2 days, hospital volume had no effect on mortality. For medical patients, higher mortality may occur in a subgroup of low-volume hospitals that do not routinely transfer their patients to larger-volume facilities. This finding needs further investigation in a larger-sized study.