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Relationship between institutional ventilated COVID-19 case volume and in-hospital death: A multicenter cohort study

Shunsuke Amagasa1, Satoko Uematsu2, Mitsuru Kubota2

  • 1Division of Emergency and Transport Services, National center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan.

Plos One
|June 15, 2023
PubMed

Insights

This study found no significant link between hospital case volume and mortality for severe COVID-19 patients requiring ventilation. Higher volume centers did not show better outcomes for ventilated coronavirus disease 2019 patients.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Health Services Research

Background:

  • The relationship between hospital case volume and patient outcomes for severe Coronavirus disease 2019 (COVID-19) remains unclear.
  • Understanding this volume-outcome relationship is crucial for developing effective medical care systems for severe COVID-19 patients.

Purpose of the Study:

  • To investigate the association between institutional case volume and patient outcomes in severe COVID-19 cases requiring mechanical ventilation.
  • To determine if higher-volume centers lead to improved survival rates for critically ill COVID-19 patients.

Main Methods:

  • Retrospective analysis of 561 patients with severe COVID-19 requiring mechanical ventilation from the J-RECOVER study (January-September 2020, Japan).
  • Institutions were categorized into low-volume (<11 cases), middle-volume (11-25 cases), and high-volume (>25 cases) based on ventilated COVID-19 patient volume.
  • Multivariate logistic regression was used to analyze in-hospital mortality, adjusting for propensity scores and in-hospital variables.

Main Results:

  • Analysis included 561 patients across 36 low-volume, 14 middle-volume, and 5 high-volume institutions.
  • After adjustments, no significant difference in in-hospital mortality was observed between middle-volume (aOR 0.77, 95% CI 0.46-1.29) or high-volume (aOR 0.76, 95% CI 0.44-1.33) centers compared to low-volume centers.
  • These findings suggest that institutional case volume may not significantly impact mortality for ventilated COVID-19 patients.

Conclusions:

  • The study suggests a potential lack of significant association between institutional case volume and in-hospital mortality for patients with severe, ventilated COVID-19.
  • Further research may be needed to confirm these findings and explore other factors influencing outcomes in severe COVID-19 care.
Abstract

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