PURPOSE: There is research in medicine to support that hospitals treating high volumes of a particular disease have lower mortality rates than those with low volumes. We hypothesize that severe sepsis at our 15 hospital health system (HS) follows that trend.
METHODS: Patients with severe sepsis were identified at baseline period in 2004 and compared with a group in follow up from 2005 through June 2006. Continuous variables were analyzed with the Mann-Whitney U test and categorical data was analyzed with the Chi-Square test. The p value was set to 0.05. Sepsis definitions, comorbidity definitions, infection group classifications and Intensive Care Unit visits were specifically defined for this review.
RESULTS: 27,330 patients were identified in our health system with severe sepsis during the follow up period. For tertiary hospitals (TH) n=16727. For community hospitals (CH) n=10603. Length of stay was significantly longer in TH (20 days vs. 18 days p<0.001) but mortality was greater in CH (26% vs. 25% p=0.0031). Age and sex differences were seen. The mean age at the TH was less than the CH (69 vs 76 p<0.001). More males were seen in the TH (50% vs. 47% p<0.001). The incidence of respiratory and hematologic acute organ dysfunction was higher at TH (40% vs 32% for respiratory p<0.001 and 18% vs. 16% for hematologic p<0.001). For neurologic organ dysfunction, there was a higher incidence in CH (12% vs 11% p=0.0012). The number of patients with only one organ dysfunction was greater in the CH (69% vs. 66% p<0.001), but the number of patients with less than 5 comorbidities was greater in the TH (73% vs. 69% p<0.001).
CONCLUSION: Our 15 hospital HS has demonstrated a similar outcome that was previously observed and described a lower mortality in the severe sepsis group at the TH sites which treat a larger volume of these patients.
CLINICAL IMPLICATIONS: Our data suggests that age difference may be predictive of mortality in severe sepsis when comparing TH and CH.
DISCLOSURE: Alan Multz, No Financial Disclosure Information; No Product/Research Disclosure Information