tetano
Editor, Senior Moderator
PLoS One
. 2023 Jun 15;18(6):e0287310.
doi: 10.1371/journal.pone.0287310. eCollection 2023. Relationship between institutional ventilated COVID-19 case volume and in-hospital death: A multicenter cohort study
Shunsuke Amagasa[SUP] 1 [/SUP], Satoko Uematsu[SUP] 2 [/SUP], Mitsuru Kubota[SUP] 2 [/SUP], Masahiro Kashiura[SUP] 3 [/SUP], Hideto Yasuda[SUP] 3 [/SUP], Mineji Hayakawa[SUP] 4 [/SUP], Kazuma Yamakawa[SUP] 5 [/SUP], Akira Endo[SUP] 6 [/SUP], Takayuki Ogura[SUP] 7 [/SUP], Atsushi Hirayama[SUP] 8 [/SUP], Hideo Yasunaga[SUP] 9 [/SUP], Takashi Tagami[SUP] 10 [/SUP]
Affiliations
Background: The volume-outcome relationship in patients with severe Coronavirus disease 2019 (COVID-19) is unclear and is important for establishing a system for the medical care of severe COVID-19. This study aimed to evaluate the association between institutional case volume and outcomes in patients with ventilated COVID-19.
Methods: We analyzed patients with severe COVID-19 on ventilatory control aged > 17 years who were enrolled in the J-RECOVER study, which is a retrospective multicenter observational study conducted between January 2020 and September 2020 in Japan. Based on the ventilated COVID-19 case volume, the higher one-third of institutions were defined as high-volume centers, the middle one-third as middle-volume centers, and the lower one-third as low-volume centers. The primary outcome measure was in-hospital mortality during hospitalization due to COVID-19. Multivariate logistic regression analysis for in-hospital mortality and ventilated COVID-19 case volume was performed after adjusting for multiple propensity scores and in-hospital variables. To estimate the multiple propensity score, we fitted a multinomial logistic regression model, which fell into one of the three groups based on patient demographics and prehospital factors.
Results: We analyzed 561 patients who required ventilator management. In total, 159, 210, and 192 patients were admitted to low-volume (36 institutions, < 11 severe COVID-19 cases per institution during the study period), middle-volume (14 institutions, 11-25 severe cases per institution), and high-volume (5 institutions, > 25 severe cases per institution) centers, respectively. After adjustment for multiple propensity scores and in-hospital variables, admission to middle- and high-volume centers was not significantly associated with in-hospital death compared with admission to low-volume centers (adjusted odds ratio, 0.77 [95% confidence interval (CI): 0.46-1.29] and adjusted odds ratio, 0.76 [95% CI: 0.44-1.33], respectively).
Conclusions: There may be no significant relationship between institutional case volume and in-hospital mortality in patients with ventilated COVID-19.
. 2023 Jun 15;18(6):e0287310.
doi: 10.1371/journal.pone.0287310. eCollection 2023. Relationship between institutional ventilated COVID-19 case volume and in-hospital death: A multicenter cohort study
Shunsuke Amagasa[SUP] 1 [/SUP], Satoko Uematsu[SUP] 2 [/SUP], Mitsuru Kubota[SUP] 2 [/SUP], Masahiro Kashiura[SUP] 3 [/SUP], Hideto Yasuda[SUP] 3 [/SUP], Mineji Hayakawa[SUP] 4 [/SUP], Kazuma Yamakawa[SUP] 5 [/SUP], Akira Endo[SUP] 6 [/SUP], Takayuki Ogura[SUP] 7 [/SUP], Atsushi Hirayama[SUP] 8 [/SUP], Hideo Yasunaga[SUP] 9 [/SUP], Takashi Tagami[SUP] 10 [/SUP]
Affiliations
- PMID: 37319278
- DOI: 10.1371/journal.pone.0287310
Background: The volume-outcome relationship in patients with severe Coronavirus disease 2019 (COVID-19) is unclear and is important for establishing a system for the medical care of severe COVID-19. This study aimed to evaluate the association between institutional case volume and outcomes in patients with ventilated COVID-19.
Methods: We analyzed patients with severe COVID-19 on ventilatory control aged > 17 years who were enrolled in the J-RECOVER study, which is a retrospective multicenter observational study conducted between January 2020 and September 2020 in Japan. Based on the ventilated COVID-19 case volume, the higher one-third of institutions were defined as high-volume centers, the middle one-third as middle-volume centers, and the lower one-third as low-volume centers. The primary outcome measure was in-hospital mortality during hospitalization due to COVID-19. Multivariate logistic regression analysis for in-hospital mortality and ventilated COVID-19 case volume was performed after adjusting for multiple propensity scores and in-hospital variables. To estimate the multiple propensity score, we fitted a multinomial logistic regression model, which fell into one of the three groups based on patient demographics and prehospital factors.
Results: We analyzed 561 patients who required ventilator management. In total, 159, 210, and 192 patients were admitted to low-volume (36 institutions, < 11 severe COVID-19 cases per institution during the study period), middle-volume (14 institutions, 11-25 severe cases per institution), and high-volume (5 institutions, > 25 severe cases per institution) centers, respectively. After adjustment for multiple propensity scores and in-hospital variables, admission to middle- and high-volume centers was not significantly associated with in-hospital death compared with admission to low-volume centers (adjusted odds ratio, 0.77 [95% confidence interval (CI): 0.46-1.29] and adjusted odds ratio, 0.76 [95% CI: 0.44-1.33], respectively).
Conclusions: There may be no significant relationship between institutional case volume and in-hospital mortality in patients with ventilated COVID-19.