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