title: The effect of hospital volume on mortality in patients admitted with severe sepsis.
abstract: OBJECTIVE
  The association between hospital volume and inpatient mortality for severe sepsis is unclear.
  
  
  OBJECTIVE
  To assess the effect of severe sepsis case volume and inpatient mortality.
  
  
  METHODS
  Retrospective cohort study from 646,988 patient discharges with severe sepsis from 3,487 hospitals in the Nationwide Inpatient Sample from 2002 to 2011.
  
  
  METHODS
  The exposure of interest was the mean yearly sepsis case volume per hospital divided into tertiles.
  
  
  METHODS
  Inpatient mortality.
  
  
  RESULTS
  Compared with the highest tertile of severe sepsis volume (>60 cases per year), the odds ratio for inpatient mortality among persons admitted to hospitals in the lowest tertile (≤10 severe sepsis cases per year) was 1.188 (95% CI: 1.074-1.315), while the odds ratio was 1.090 (95% CI: 1.031-1.152) for patients admitted to hospitals in the middle tertile. Similarly, improved survival was seen across the tertiles with an adjusted inpatient mortality incidence of 35.81 (95% CI: 33.64-38.03) for hospitals with the lowest volume of severe sepsis cases and a drop to 32.07 (95% CI: 31.51-32.64) for hospitals with the highest volume.
  
  
  CONCLUSIONS
  We demonstrate an association between a higher severe sepsis case volume and decreased mortality. The need for a systems-based approach for improved outcomes may require a high volume of severely septic patients.
authors.affiliation: Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Sajid
authors.initials: S
authors.lastname: Shahul
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Hacker
authors.affiliation: Clinical Research Centre, Soroka University Medical Centre and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Victor
authors.initials: V
authors.lastname: Novack
authors.affiliation: Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Ariel
authors.initials: A
authors.lastname: Mueller
authors.affiliation: Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Shahzad
authors.initials: S
authors.lastname: Shaefi
authors.affiliation: Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Bilal
authors.initials: B
authors.lastname: Mahmood
authors.affiliation: Washington and Lee University, Lexington, Virginia, United States of America.
authors.forename: Syed Haider
authors.initials: SH
authors.lastname: Ali
authors.affiliation: Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Daniel
authors.initials: D
authors.lastname: Talmor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality*; D055815:Young Adult