What does this research mean for the field?

In patients with acute symptomatic pulmonary embolism, admission to high-volume hospitals is associated with a 44% reduction in adjusted 30-day pulmonary embolism-related mortality compared to admission to low-volume hospitals. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the association between hospital case volume and 30-day mortality in patients presenting with acute symptomatic pulmonary embolism.

July 29, 2019BMJOpen Access

Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study

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Why the study?

To evaluate the association between hospital experience in managing acute pulmonary embolism, reflected by case volume, and mortality.

Does admission to high volume hospitals reduce pulmonary embolism related mortality at 30 days in patients with acute symptomatic pulmonary embolism?

Key Points

To evaluate the association between hospital case volume and 30-day mortality in patients presenting with acute symptomatic pulmonary embolism.
Analyzed data from 39,257 consecutive patients with confirmed acute symptomatic pulmonary embolism across 353 hospitals in 16 countries using the RIETE registry (2001–2018).
Compared 30-day outcomes between hospitals in the highest annual volume quartile (>40 cases/year) and lowest annual volume quartile (<15 cases/year).
Admission to high-volume hospitals was associated with a 44% lower odds of 30-day PE-related mortality compared with low-volume hospitals (adjusted risk 1.3% vs 2.3%; adjusted OR 0.56, 95% CI 0.33 to 0.95; P=0.03).
No statistically significant differences were observed between high- and low-volume hospitals for 30-day all-cause mortality (adjusted OR 0.78, 95% CI 0.50 to 1.22; P=0.28), recurrent venous thromboembolism (OR 0.76, 95% CI 0.49 to 1.19), or major bleeding (OR 1.07, 95% CI 0.77 to 1.47).

Structured PICO

Does admission to high volume hospitals reduce pulmonary embolism related mortality at 30 days in patients with acute symptomatic pulmonary embolism?

Population

39,257 consecutive patients with confirmed diagnosis of acute symptomatic pulmonary embolism from 353 hospitals in 16 countries.

Intervention

Admission to high volume hospitals (highest quarter, >40 pulmonary embolisms per year).

Comparator

Admission to low volume hospitals (lowest quarter, <15 pulmonary embolisms per year).

Outcome

Pulmonary embolism related mortality within 30 days after diagnosis of the condition.hard clinical

Admission to high-volume hospitals for acute pulmonary embolism is associated with a significant reduction in 30-day PE-related mortality, suggesting a volume-outcome relationship that may impact triage and management strategies.

Limitations

Possibility of residual confounding despite adjustment for multiple variables
Single data point of initial blood pressure and heart rate used to define severity
Observational design cannot determine causality
Cohort might include hospitals enthusiastic about evidence based management of pulmonary embolism (selection bias)

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

High-volume admission was associated with lower PE mortality; leaves open whether volume-based triage improves outcomes.

Cite This Study

Jiménez et al. (2019) studied this question.

synapsesocial.com/papers/6a197959dec6c1694ed996df https://doi.org/10.1136/bmj.l4416

Topics

Pulmonary embolism

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Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Topics

Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider