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Updated: Apr 23, 2026
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The effect of hospital volume on mortality in patients admitted with severe sepsis
Sajid Shahul1, Michele R Hacker2, Victor Novack3
1Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America.
Importance:
The association between hospital volume and inpatient mortality for severe sepsis is unclear.
Objective:
To assess the effect of severe sepsis case volume and inpatient mortality.
Design Setting And Participants:
Retrospective cohort study from 646,988 patient discharges with severe sepsis from 3,487 hospitals in the Nationwide Inpatient Sample from 2002 to 2011.
Exposures:
The exposure of interest was the mean yearly sepsis case volume per hospital divided into tertiles.
Main Outcomes And Measures:
Inpatient mortality.
Results:
Compared with the highest tertile of severe sepsis volume (>60 cases per year), the odds ratio for inpatient mortality among persons admitted to hospitals in the lowest tertile (≤10 severe sepsis cases per year) was 1.188 (95% CI: 1.074-1.315), while the odds ratio was 1.090 (95% CI: 1.031-1.152) for patients admitted to hospitals in the middle tertile. Similarly, improved survival was seen across the tertiles with an adjusted inpatient mortality incidence of 35.81 (95% CI: 33.64-38.03) for hospitals with the lowest volume of severe sepsis cases and a drop to 32.07 (95% CI: 31.51-32.64) for hospitals with the highest volume.
Conclusions And Relevance:
We demonstrate an association between a higher severe sepsis case volume and decreased mortality. The need for a systems-based approach for improved outcomes may require a high volume of severely septic patients.
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