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Association Between In-Hospital Mortality and ICU Patient Volume at the Facility-Level Stratified by Severity
Takuya Sato1, Yusuke Sasabuchi2, Yoshihisa Miyamoto2
1Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Critical Care Medicine
|August 5, 2026
Summary
Higher intensive care unit (ICU) patient volumes, especially for critically ill patients, correlate with lower in-hospital mortality. This volume-outcome relationship strengthens as patient severity, measured by Sequential Organ Failure Assessment (SOFA) scores, increases.
Area of Science:
- Critical Care Medicine
- Health Services Research
- Epidemiology
Background:
- Large-volume hospitals for critically ill patients often show improved outcomes.
- The combined effect of intensive care unit (ICU) volume and patient severity on outcomes requires further evaluation.
Purpose of the Study:
- To determine the impact of ICU patient volume, stratified by Sequential Organ Failure Assessment (SOFA) scores, on mortality.
- To clarify the effect of ICU volume within specific patient severity ranges.
Main Methods:
- Retrospective observational study utilizing the Japanese Diagnosis Procedure Combination inpatient database.
- Analysis of 568,340 adult ICU admissions across 430 hospitals from October 2020 to March 2023.
- Multilevel mixed-effects logistic regression models to assess the association between ICU volume (stratified by SOFA score thresholds) and in-hospital mortality.
Main Results:
- Total ICU volume was not significantly associated with in-hospital mortality.
- Increased volume of ICU patients with SOFA scores above 5 was significantly associated with decreased in-hospital mortality (OR, 0.997; p < 0.001).
- An enhanced inverse association between ICU volume and mortality was observed as the SOFA score threshold increased.
Conclusions:
- Higher volumes of critically ill patients in ICUs are linked to reduced in-hospital mortality.
- The volume-outcome relationship is more pronounced for patients with higher severity levels, as indicated by SOFA scores.
