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Understanding the Influence of Hospital Volume on Inpatient Outcomes Following Hospitalization for Status Epilepticus

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Abstract

Background

Prior studies show hospital admission volume to be associated with poor outcomes following elective procedures and inpatient medical hospitalizations. However, it is unknown whether hospital volume impacts Inpatient outcomes for status epilepticus (SE) hospitalizations. In this study, we aimed to assess the impact of hospital volume on the outcome of patients with SE and related inpatient medical complications.

Methods

The 2005 to 2013 National Inpatient Sample database was queried using International Classification of Diseases 9th Edition diagnosis code 345.3 to identify patients undergoing acute hospitalization for SE. The National Inpatient Sample hospital identifier was used as a unique facility identifier to calculate the average volume of patients with SE seen in a year. The study cohort was divided into three groups: low volume (0–7 patients with SE per year), medium volume (8–22 patients with SE per year), and high volume (> 22 patients with SE per year). Multivariate logistic regression analyses were used to assess whether medium or high hospital volume had lower rates of inpatient medical complications compared with low-volume hospitals.

Results

A total of 137,410 patients with SE were included in the analysis. Most patients (n = 50,939; 37%) were treated in a low-volume hospital, 31% (n = 42,724) were treated in a medium-volume facility, and 18% (n = 25,207) were treated in a high-volume hospital. Patients undergoing treatment at medium-volume hospitals (vs. low-volume hospitals) had higher odds of pulmonary complications (odds ratio [OR] 1.18 [95% confidence interval {CI} 1.12–1.25]; p < 0.001), sepsis (OR 1.24 [95% CI 1.08–1.43] p = 0.002), and length of stay (OR 1.13 [95% CI 1.0 –1.19] p < 0.001). High-volume hospitals had significantly higher odds of urinary tract infections (OR 1.21 [95% CI 1.11–1.33] p < 0.001), pulmonary complications (OR 1.19 [95% CI 1.10–1.28], p < 0.001), thrombosis (OR 2.13 [95% CI 1.44–3.14], p < 0.001), and renal complications (OR 1.21 [95% CI 1.07–1.37], p = 0.002). In addition, high-volume hospitals had lower odds of metabolic (OR 0.81 [95% CI 0.72–0.91], p < 0.001), neurological complications (OR 0.80 [95% CI 0.69–0.93], p = 0.004), and disposition to a facility (OR 0.89 [95% CI 0.82–0.96], p < 0.001) compared with lower-volume hospitals.

Conclusions

Our study demonstrates certain associations between hospital volume and outcomes for SE hospitalizations. Further studies using more granular data about the type, severity, and duration of SE and types of treatment are warranted to better understand how hospital volume may impact care and prognosis of patients.

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Authors and Affiliations

  1. Department of Neurology, Wayne State University School of Medicine, Detroit Medical Center, 4201 St. Antoine, UHC-8D, Detroit, MI, 48098, USA

    Maryam J. Syed, Deepti Zutshi, Ayaz Khawaja, Maysaa M. Basha & Rohit Marawar

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  1. Maryam J. Syed
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  2. Deepti Zutshi
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  3. Ayaz Khawaja
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  4. Maysaa M. Basha
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Contributions

MJS MBBS: concept, data acquisition, data analysis, article writing, and article review. DZ MD: concept, article writing, and article review. AK MD: concept, data acquisition, data analysis, article writing, and article review. MMB MD: concept, article writing, and article review. RM MD: concept, data acquisition, data analysis, article writing, and article review. The final manuscript was approved by all authors.

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Correspondence to Maryam J. Syed.

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Maysaa Basha and Rohit Marawar have received funds for Investigator-Initiated studies from Eisai Co Ltd. Maryam J. Syed, Deepti Zutshi, and Ayaz Khawaja declare that they have no conflict of interest.

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Syed, M.J., Zutshi, D., Khawaja, A. et al. Understanding the Influence of Hospital Volume on Inpatient Outcomes Following Hospitalization for Status Epilepticus. Neurocrit Care 38, 26–34 (2023). https://doi.org/10.1007/s12028-022-01656-3

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  • DOI: https://doi.org/10.1007/s12028-022-01656-3

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