Hospital Volume and Mortality in Mechanically Ventilated Children: Analysis of a National Inpatient Database in Japan

Abstract

Objectives: To evaluate the relationship between annual hospital volume of mechanical ventilation in children and mortality.

Design: A retrospective analysis.

Setting: Japanese hospitals (n = 641) in the Japanese Diagnosis Procedure Combination database from July 2010 to March 2013.

Patients: Patients 15 years old or younger receiving mechanical ventilation during hospitalization.

Interventions: None.

Measurements and main results: A total of 26,981 mechanically ventilated pediatric patients were identified. They were categorized into four subgroups based on the quartiles of mean annual hospital volume of mechanical ventilation in children. Multivariable logistic regression analyses were performed to examine the effects of hospital volume on 30-day mortality, with adjustment for patient and hospital characteristics. Compared with the low volume group (≤ 34 per year), the odds ratios (95% CI) for 30-day mortality of low-medium (35-80), medium-high (81-165), and high (≥ 166) volume groups were 0.63 (0.50-0.79), 0.56 (0.42-0.74), and 0.57 (0.50-0.79), respectively. Subgroup analyses of surgical and nonsurgical patients showed similar trends.

Conclusions: In mechanically ventilated pediatric patients divided by hospital volume quartiles, all three higher volume groups had lower mortality than the lowest volume group.