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Citation
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Shibahashi K, Hoda H, Oishio M, Okura Y, Sugiyama K, Hamabe Y. World Neurosurg. 2021; ePub(ePub): ePub. |
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Abstract
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OBJECTIVE: The hospital volume-outcome relationship in patients with severe traumatic brain injury (TBI) remains unclear. This study investigated the association between the volume of patients with severe TBI and in-hospital mortality.
METHODS: This observational study identified patients with severe TBI (Glasgow Coma Scale score < 9 and Abbreviated Injury Scale head score ≥ 3) from the Japan Trauma Databank (2010-2018). Hospitals were grouped based on the annual patient volume as follows: low-volume (4-19 patients/year); middle-volume (20-35 patients/year); and high-volume (36-51 patients/year) groups. The association between hospital volume categories and in-hospital mortality was examined using a multivariate mixed-effect logistic regression analysis. A subgroup analysis was performed based on the presence of severe extracranial injuries.
RESULTS: A total of 11,344 patients from 64 hospitals were included. The median age of the patients was 57 years (interquartile range, 40-77) and 7,933 (70.0%) patients were men. A total of 4,879 (43.1%) patients died in the hospital. The medium-volume (adjusted odds ratio [OR], 0.76; 95% confidence interval [CI], 0.62-0.93) and high-volume (adjusted OR, 0.69; 95% CI, 0.52-0.94) groups were significantly associated with lower in-hospital mortality. The subgroup analysis revealed that the medium-volume (adjusted OR, 0.70; 95% CI, 0.54-0.92) and high-volume (adjusted OR, 0.64; 95% CI, 0.42-0.96) groups were significantly associated with lower in-hospital mortality for isolated TBI patients.
CONCLUSIONS: Higher hospital volumes were significantly associated with lower in-hospital mortality after severe TBI. Regionalization and referral to higher-volume hospitals are beneficial for severe TBI patients.
Language: en |