Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study.
Por:
Jiménez D, Bikdeli B, Quezada A, Muriel A, Lobo JL, de Miguel-Diez J, Jara-Palomares L, Ruiz-Artacho P, Yusen RD, Monreal M and RIETE Investigators
Publicada:
29 jul 2019
Ahead of Print:
29 jul 2019
Resumen:
OBJECTIVES: To evaluate the association between experience in the management of acute pulmonary embolism, reflected by hospital case volume, and mortality. DESIGN: Multinational population based cohort study using data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry between 1 January 2001 and 31 August 2018. SETTING: 353 hospitals in 16 countries. PARTICIPANTS: 39 257 consecutive patients with confirmed diagnosis of acute symptomatic pulmonary embolism. MAIN OUTCOME MEASURE: Pulmonary embolism related mortality within 30 days after diagnosis of the condition. RESULTS: Patients with acute symptomatic pulmonary embolism admitted to high volume hospitals (>40 pulmonary embolisms per year) had a higher burden of comorbidities. A significant inverse association was seen between annual hospital volume and pulmonary embolism related mortality. Admission to hospitals in the highest quarter (that is, >40 pulmonary embolisms per year) was associated with a 44% reduction in the adjusted odds of pulmonary embolism related mortality at 30 days compared with admission to hospitals in the lowest quarter (<15 pulmonary embolisms per year; adjusted risk 1.3% v 2.3%; adjusted odds ratio 0.56 (95% confidence interval 0.33 to 0.95); P=0.03). Results were consistent in all sensitivity analyses. All cause mortality at 30 days was not significantly reduced between the two quarters (adjusted odds ratio 0.78 (0.50 to 1.22); P=0.28). Survivors showed little change in the odds of recurrent venous thromboembolism (odds ratio 0.76 (0.49 to 1.19)) or major bleeding (1.07 (0.77 to 1.47)) between the low and high volume hospitals. CONCLUSIONS: In patients with acute symptomatic pulmonary embolism, admission to high volume hospitals was associated with significant reductions in adjusted pulmonary embolism related mortality at 30 days. These findings could have implications for management strategies.
Filiaciones:
Jiménez D:
Respiratory Department, Ramón y Cajal Hospital, Ramón y Cajal Institute for Health Research (IRYCIS), Madrid 28034, Spain
Medicine Department, Alcalá University, Madrid, Spain
Bikdeli B:
Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT, USA
Cardiovascular Research Foundation, New York, NY, USA
Muriel A:
Biostatistics Department, Ramón y Cajal Hospital, Ramón y Cajal Institute for Health Research (IRYCIS), CIBERESP, Madrid, Spain
Lobo JL:
Respiratory Department, Araba Hospital, Vitoria, Spain
de Miguel-Diez J:
Respiratory Department, Gregorio Marañón Hospital, Madrid, Spain
Jara-Palomares L:
Respiratory Department, Virgen del Rocío Hospital, Institute of Biomedicine of Seville, CIBERES, Seville, Spain
Ruiz-Artacho P:
Department of Internal Medicine, Clinica Universidad de Navarra, Madrid, Spain
Yusen RD:
Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St Louis, MO, USA
Monreal M:
Department of Internal Medicine, Germans Trias i Pujol University Hospital, Badalona, Spain
Catholic University of Murcia, Murcia, Spain
Open Access
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