Acute PE survival is linked to hospital volume

  • Jiménez D & al.
  • BMJ
  • 29 jul. 2019

  • de Jenny Blair, MD
  • Clinical Essentials
El acceso al contenido completo es sólo para profesionales sanitarios registrados. El acceso al contenido completo es sólo para profesionales sanitarios registrados.

Takeaway

  • Patients admitted with acute symptomatic pulmonary embolism (PE) have higher survival rates if admitted to hospitals with more experience caring for PE patients.
  • The higher the volume, the less likely is PE-related death.

Why this matters

  • Higher hospital case volume has been tied to better outcomes in a range of medical and surgical problems.
  • For PE, treatment is complex and high-stakes, patients are at considerable risk for complications, and standards of care are changing.

Key results

  • Higher hospital volume correlated with lower adjusted PE-related mortality (Ptrend=.04).
  • Adjusted PE-related mortality risk:
    • Lowest-volume quartile: 2.3%.
    • Highest-volume quartile: 1.3%.
  • Adjusted mortality reduction vs lowest-quartile hospital (quartile 1):
    • Highest quartile (quartile 4): 44% (P=.03).
    • Quartile 3: 39% (P=.05).
    • Quartile 2: 34% (P=.06).
  • Similar results upon sensitivity analyses.
  • Patients admitted to lower-volume hospitals were less likely to receive guideline-based treatment. 

Study design

  • Population-based cohort study of the 16-country Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) Registry, 2001-2018 (n=39,257).
  • Authors ranked hospitals by quartiles by annual number of PE patients admitted.
  • Adjusting for numerous confounders, they compared volumes with outcomes in consecutive patients with confirmed PE.
  • Outcomes: 30-day PE-related mortality.
  • Funding: None.

Limitations

  • Potential residual confounding.
  • Reasons for higher survival rates unknown.
  • Causation not established.