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Volume-outcome relationship in neurotrauma care
R Carter Clement1, Brendan G Carr, Michael J Kallan
1Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Journal of Neurosurgery
|December 18, 2012
Summary
A volume-outcome relationship (VOR) in neurotrauma care shows improved survival at centers treating at least 6 patients annually. Patient volume did not significantly impact the cost of care.
Area of Science:
- Neurosurgery
- Trauma Care
- Health Services Research
Background:
- Numerous studies support a positive correlation between patient volume and outcomes.
- Volume-outcome relationships (VORs) and volume-cost relationships (VCRs) are established concepts in healthcare.
- Existing research on VCRs in neurotrauma yields mixed results.
Purpose of the Study:
- To investigate VORs and VCRs in the treatment of common intracranial injuries.
- To test the hypothesis that outcomes are poorer at low-volume centers.
- To test the hypothesis that costs increase at high-volume centers.
Main Methods:
- Cross-sectional cohort study using the 2006 Nationwide Inpatient Sample.
- Identified patients with subdural, subarachnoid, and extradural hemorrhage using ICD-9 codes.
- Logistic regression analysis to assess the association between neurotrauma patient volume and survival, discharge status, and cost.
Main Results:
- In-hospital mortality was 14.9% for centers with <6 neurotrauma cases annually, significantly higher than centers treating 6+ cases.
- Facilities treating 6-11, 12-23, 24-59, and 60+ patients annually showed significantly reduced mortality risk compared to the lowest volume group.
- No statistically significant differences in estimated actual cost or duration of hospital stay were found across different patient volume groups.
Conclusions:
- A significant volume-outcome relationship exists in neurotrauma treatment.
- A threshold of 6 cases per year appears critical for improved patient mortality.
- Current evidence suggests patient volume does not significantly affect the cost of neurotrauma care.
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