Hospital experience and mortality in patients with systemic lupus erythematosus

To determine if a hospital's experience in treating patients with systemic lupus erythematosus (SLE) is associated with in-hospital mortality among patients with this condition.

The California Hospital Discharge Database, which contains information on all discharges from acute-care hospitals in California, was used to identify patients with SLE hospitalized from 1991 to 1994 (n = 9,989). The risks of in-hospital mortality were compared between patients admitted to hospitals in which there was a high degree of experience (those with an average of >50 urgent or emergency SLE admissions per year) and those in which there was less experience.

Patients admitted on an urgent or emergency basis to hospitals in which there was a high degree of experience had a slightly lower risk of in-hospital mortality than patients admitted to hospitals in which there was less experience (mortality 3.8% versus 5.3%; adjusted odds ratio [OR] 0.72, 95% confidence interval [95% CI] 0.50-1.04). In the subset of 2,372 patients hospitalized on an emergency basis, those admitted to hospitals in which there was a high degree of experience had a risk of in-hospital mortality that was 66% lower than that of patients admitted to hospitals in which there was less experience (mortality 4.2% versus 11.3%; adjusted OR 0.34, 95% CI 0.19-0.58). In the subset of 405 patients hospitalized on an emergency basis due to SLE, those admitted to hospitals in which there was a high degree of experience had a risk of in-hospital mortality that was 95% lower than that of patients admitted to hospitals in which there was less experience (mortality 1.7% versus 10.0%; adjusted OR 0.05, 95% CI 0.006-0.34). Among those with emergency hospitalizations for any reason or emergency hospitalizations due to SLE, lengths of stay and total costs did not differ between patients hospitalized at hospitals in which there was a high degree of experience and hospitals in which there was less experience.

In-hospital mortality among patients with SLE is lower at hospitals in which there is more experience in caring for patients with SLE. This association is strongest among patients hospitalized on an emergency basis due to SLE.