title: Lower mortality for abdominal aortic aneurysm repair in high-volume hospitals is contingent upon nurse staffing.
abstract: OBJECTIVE
  To determine whether and to what extent the lower mortality rates for patients undergoing abdominal aortic aneurysm (AAA) repair in high-volume hospitals is explained by better nursing.
  
  
  METHODS
  State hospital discharge data, Multi-State Nursing Care and Patient Safety Survey, and hospital characteristics from the AHA Annual Survey.
  
  
  METHODS
  Cross-sectional analysis of linked patient outcomes for individuals undergoing AAA repair in four states.
  
  
  METHODS
  Secondary data sources.
  
  
  RESULTS
  Favorable nursing practice environments and higher hospital volumes of AAA repair are associated with lower mortality and fewer failures-to-rescue in main-effects models. Furthermore, nurse staffing interacts with volume such that there is no mortality advantage observed in high-volume hospitals with poor nurse staffing. When hospitals have good nurse staffing, patients in low-volume hospitals are 3.4 times as likely to die and 2.6 times as likely to die from complications as patients in high-volume hospitals (p < .001).
  
  
  CONCLUSIONS
  Nursing is part of the explanation for lower mortality after AAA repair in high-volume hospitals. Importantly, lower mortality is not found in high-volume hospitals if nurse staffing is poor.
authors.affiliation: Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, PA 19104-4217, USA. wiltse@nursing.upenn.edu
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Wiltse Nicely
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Sloane
authors.forename: Linda H
authors.initials: LH
authors.lastname: Aiken
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery*; D003430:Cross-Sectional Studies; D004522:Educational Status; D004777:Environment; D005260:Female; D006302:Health Services Research; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015401:Nursing Administration Research; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data*; D061214:Patient Safety / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States; D017132:Workplace / Q000706:statistics & numerical data