TY  - JOUR
PY  - 2017//
TI  - Understanding hospital volume-outcome relationship in severe traumatic brain injury
JO  - Neurosurgery
A1  - Alali, Aziz S.
A1  - Gómez, David
A1  - McCredie, Victoria
A1  - Mainprize, Todd G.
A1  - Nathens, Avery B.
SP  - 534
EP  - 542
VL  - 80
IS  - 4
N2  - BACKGROUND: The hospital volume-outcome relationship in severe traumatic brain injury (TBI) population remains unclear. <br><br>OBJECTIVE: To examine the relationship between volume of patients with severe TBI per hospital and in-hospital mortality, major complications, and mortality following a major complication (ie, failure to rescue). <br><br>METHODS: In a multicenter cohort study, data on 9255 adults with severe TBI were derived from 111 hospitals participating in the American College of Surgeons Trauma Quality Improvement Program over 2009-2011. Hospitals were ranked into quartiles based on their volume of severe TBI during the study period. Random-intercept multilevel models were used to examine the association between hospital quartile of severe TBI volume and in-hospital mortality, major complications, and mortality following a major complication after adjusting for patient and hospital characteristics. In sensitivity analyses, we examined these associations after excluding transferred cases. <br><br>RESULTS: Overall mortality was 37.2% (n = 3447). Two thousand ninety-eight patients (22.7%) suffered from 1 or more major complication. Among patients with major complications, 27.8% (n = 583) died. Higher-volume hospitals were associated with lower mortality; the adjusted odds ratio of death was 0.50 (95% confidence interval: 0.29-0.85) in the highest volume quartile compared to the lowest. There was no significant association between hospital-volume quartile and the odds of a major complication or the odds of death following a major complication. After excluding transferred cases, similar results were found. <br><br>CONCLUSION: High-volume hospitals might be associated with lower in-hospital mortality following severe TBI. However, this mortality reduction was not associated with lower risk of major complications or death following a major complication.<p />  <p>Language: en</p>
LA  - en
SN  - 0148-396X
UR  - http://dx.doi.org/10.1093/neuros/nyw098
ID  - ref1
ER  -