Sepsis: Hospital Case Volume and Outcomes

Allan J. Walkey, M.D., M.Sc Boston University School of Medicine Pulmonary Center Boston, MassachusettsMedicalResearch.com Interview with:
Allan J. Walkey, M.D., M.Sc
Boston University School of Medicine
Pulmonary Center
Boston, Massachusetts

MedicalResearch.com: What are the main findings of the study?

Dr. Walkey: Thank you for the interest in our study.  Current evidence-based treatments for severe sepsis (ie, infection+systemic inflammatory response+ end organ dysfunction) include specific processes of care rather specific therapeutics.  These processes include early administration of antibiotics, early fluid resuscitation, and lung protective ventilation strategies.  We hypothesized that hospitals with more ‘practice’ at treating patients with severe sepsis may have more effective care processes leading to improved patient outcomes.  We examined more than 15,000 severe sepsis admissions from 124 US academic medical centers. Our findings supported our hypothesis. After adjustment for patient severity of illness and hospital characteristics, mortality in the highest quartile severe sepsis case volume hospitals was 22% and  mortality in lowest severe sepsis case volume hospitals was 29%.  The 7% absolute mortality difference would result in an estimated number needed to treat in high severe sepsis volume hospitals to prevent one death in low case volume hospitals of 14 (though we advise caution in interpretation of a number needed to treat in an observational study). Costs and length of stay were not different across levels of severe sepsis case volume.  Results were robust to multiple subgroup and sensitivity analyses.


MedicalResearch.com: Were any of the findings unexpected?

Dr. Walkey: We were surprised that the case volume-outcome association was weaker among surgical patients than among medical patients.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Walkey: Hospital-level processes of care likely make a difference when it comes to improving mortality for patients with severe sepsis.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Walkey: We need to determine which specific processes are most highly associated with improved outcomes in severe sepsis.

Citation:

Hospital Case Volume and Outcomes among Patients Hospitalized with Severe Sepsis

Dr. Allan J Walkey and Dr. Renda Soylemez Wiener
American Journal of Respiratory and Critical Care Medicine 0 0:ja

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