ArticleHealth services research2009
The relationship between hospital volume and mortality in mechanical ventilation: an instrumental variable analysis.
Article in Health services research, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
44 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The Volume-Outcome Relationship in Critical Care: A Systematic Review and Meta-analysis.Chest · 2015Pooled it
- Does patient volume affect clinical outcomes in adult intensive care units?Intensive care medicine · 2012Pooled it
- The intensive care unit balancing act: integrated staffing models for better patient ratios.Critical care science · 2026Article
- The Impact of Hospital Delivery Volumes of Newborns Born Very Preterm on Mortality and Morbidity.The Journal of pediatrics · 2025Observational
- Article
- Understanding the Influence of Hospital Volume on Inpatient Outcomes Following Hospitalization for Status Epilepticus.Neurocritical care · 2023Article
- Relationship between institutional ventilated COVID-19 case volume and in-hospital death: A multicenter cohort study.PloS one · 2023Observational
- Relationship between institutional intensive care volume prior to the COVID-19 pandemic and in-hospital death in ventilated patients with severe COVID-19.Scientific reports · 2022Observational
- Surgeon Variation in Perioperative Opioid Prescribing and Medium- or Long-term Opioid Utilization after Total Knee Arthroplasty: A Cross-sectional Analysis.Anesthesiology · 2022Article
- What underlies the observed hospital volume-outcome relationship?BMC health services research · 2022Article
- Exploring relationships between in-hospital mortality and hospital case volume using random forest: results of a cohort study based on a nationwide sample of German hospitals, 2016-2018.BMC health services research · 2022Article
- The association between cardiac intensive care unit mechanical ventilation volumes and in-hospital mortality.European heart journal. Acute cardiovascular care · 2021Article
- Time spent in prior hospital stay and outcomes for ventilator patients in long-term acute care hospitals.BMC pulmonary medicine · 2021Article
- Optimal surgeon and hospital volume thresholds to reduce mortality and length of stay for CABG.PloS one · 2021Article
- Assessing delivery of mechanical ventilation: risks and benefits of large databases.Intensive care medicine · 2020Article
- Hospital Mechanical Ventilation Volume and Patient Outcomes: Too Much of a Good Thing?Critical care medicine · 2019Article
- The Association Between Acute Respiratory Distress Syndrome Hospital Case Volume and Mortality in a U.S. Cohort, 2002-2011.Critical care medicine · 2018Article
- Impact on mortality of prompt admission to critical care for deteriorating ward patients: an instrumental variable analysis using critical care bed strain.Intensive care medicine · 2018Article
- Physician-Level Variation in Outcomes of Mechanically Ventilated Patients.Annals of the American Thoracic Society · 2018Article
- Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
objectiveTo examine the relationship between hospital volume and mortality for nonsurgical patients receiving mechanical ventilation. DATA SOURCES: Pennsylvania state discharge records from July 1, 2004, to June 30, 2006, linked to the Pennsylvania Department of Health death records and the 2000 United States Census. STUDY
designWe categorized all general acute care hospitals in Pennsylvania (n=169) by the annual number of nonsurgical, mechanically ventilated discharges according to previous criteria. To estimate the relationship between annual volume and 30-day mortality, we fit linear probability models using administrative risk adjustment, clinical risk adjustment, and an instrumental variable approach. PRINCIPLE
findingsUsing a clinical measure of risk adjustment, we observed a significant reduction in the probability of 30-day mortality at higher volume hospitals (>or=300 admissions per year) compared with lower volume hospitals (<300 patients per year; absolute risk reduction: 3.4%, p=.04). No significant volume-outcome relationship was observed using only administrative risk adjustment. Using the distance from the patient's home to the nearest higher volume hospital as an instrument, the volume-outcome relationship was greater than observed using clinical risk adjustment (absolute risk reduction: 7.0%, p=.01).
conclusionsCare in higher volume hospitals is independently associated with a reduction in mortality for patients receiving mechanical ventilation. Adequate risk adjustment is essential in order to obtained unbiased estimates of the volume-outcome relationship.
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