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Abstract：
BACKGROUND: Previous studies have explored the association between the number of cases and patient outcomes for critical illnesses such as sepsis and trauma, as well as various surgeries, with the expectation that a higher number of cases would have a more favorable effect on patient outcomes. The aim of this study was to elucidate the association among intensive care unit (ICU) case volume, specialization, and patient outcomes in critically ill emergency patients and to determine how ICU case volumes and specializations impact the outcomes of these patients in Japanese ICUs.
METHODS: Utilizing data from the Japanese Intensive Care PAtient Database (JIPAD) from April 2015 to March 2021, this retrospective cohort study was conducted in 80 ICUs across Japan and included 72,214 emergency patients aged ≥ 16 years. The primary outcome measure was in-hospital mortality, and the secondary outcomes encompassed ICU mortality, 28-day mortality, ventilator-free days, and the lengths of ICU and hospital stays. Bayesian hierarchical generalized linear mixed models were used to adjust for patient- and ICU-level variables.
RESULTS: This study revealed a significant association between a higher ICU case volume and decreased in-hospital mortality. In particular, ICUs with a higher percentage (> 75%) of emergency patients showed more pronounced effects, with the odds ratios for in-hospital mortality in the higher case volume quartiles (Q2, Q3, and Q4) being 0.92 (95% credible interval [CI]: 0.88-0.96), 0.70 (95% CI: 0.67-0.73), and 0.78 (95% CI: 0.73-0.83), respectively, compared with the lowest quartile (Q1). Similar trends were observed for various secondary outcomes.
CONCLUSIONS: Higher ICU case volumes were significantly associated with lower in-hospital mortality rates in Japanese ICUs predominantly treating critically ill emergency patients. These findings emphasize the importance of ICU specialization and highlight the potential benefits of centralized care for critically ill emergency patients. These findings are potential insights for improving health care policy in Japan and may be valuable in emergency care settings in other countries with similar healthcare systems, after careful consideration of contextual differences.
METHODS: Utilizing data from the Japanese Intensive Care PAtient Database (JIPAD) from April 2015 to March 2021, this retrospective cohort study was conducted in 80 ICUs across Japan and included 72,214 emergency patients aged ≥ 16 years. The primary outcome measure was in-hospital mortality, and the secondary outcomes encompassed ICU mortality, 28-day mortality, ventilator-free days, and the lengths of ICU and hospital stays. Bayesian hierarchical generalized linear mixed models were used to adjust for patient- and ICU-level variables.
RESULTS: This study revealed a significant association between a higher ICU case volume and decreased in-hospital mortality. In particular, ICUs with a higher percentage (> 75%) of emergency patients showed more pronounced effects, with the odds ratios for in-hospital mortality in the higher case volume quartiles (Q2, Q3, and Q4) being 0.92 (95% credible interval [CI]: 0.88-0.96), 0.70 (95% CI: 0.67-0.73), and 0.78 (95% CI: 0.73-0.83), respectively, compared with the lowest quartile (Q1). Similar trends were observed for various secondary outcomes.
CONCLUSIONS: Higher ICU case volumes were significantly associated with lower in-hospital mortality rates in Japanese ICUs predominantly treating critically ill emergency patients. These findings emphasize the importance of ICU specialization and highlight the potential benefits of centralized care for critically ill emergency patients. These findings are potential insights for improving health care policy in Japan and may be valuable in emergency care settings in other countries with similar healthcare systems, after careful consideration of contextual differences.
摘要：
背景：以前的研究已经探讨了败血症和创伤等危重疾病的病例数与患者预后之间的关系，以及各种手术，期望更多的病例将对患者预后产生更有利的影响。这项研究的目的是阐明重症监护病房(ICU)病例量之间的关系，专业化,和危重急诊患者的患者结局，并确定ICU病例量和专业化如何影响日本ICU中这些患者的结局。
方法：利用2015年4月至2021年3月日本重症监护患者数据库（JIPAD）的数据，这项回顾性队列研究在日本80个ICU中进行，包括72,214名年龄≥16岁的急诊患者。主要结局指标是住院死亡率，次要结局包括ICU死亡率，28天死亡率，无呼吸机日，以及ICU和住院时间的长短。使用贝叶斯分层广义线性混合模型来调整患者和ICU级别的变量。
结果：本研究揭示了ICU病例量增加与住院死亡率降低之间的显著关联。特别是,急诊患者比例较高(>75%)的ICU表现出更明显的效果,在较高病例量四分位数（Q2，Q3和Q4）中住院死亡率的比值比为0.92（95％可信区间[CI]：0.88-0.96），0.70（95%CI：0.67-0.73），和0.78（95%CI：0.73-0.83），分别,与最低四分位数(Q1)相比。对于各种次要结果观察到类似的趋势。
结论：在主要治疗危重急诊患者的日本ICU中，较高的ICU病例量与较低的住院死亡率显著相关。这些发现强调了ICU专业化的重要性，并强调了集中护理对危重急诊患者的潜在益处。这些发现是改善日本医疗保健政策的潜在见解，并且可能在其他拥有类似医疗保健系统的国家的紧急护理环境中很有价值。在仔细考虑上下文差异之后。
方法：利用2015年4月至2021年3月日本重症监护患者数据库（JIPAD）的数据，这项回顾性队列研究在日本80个ICU中进行，包括72,214名年龄≥16岁的急诊患者。主要结局指标是住院死亡率，次要结局包括ICU死亡率，28天死亡率，无呼吸机日，以及ICU和住院时间的长短。使用贝叶斯分层广义线性混合模型来调整患者和ICU级别的变量。
结果：本研究揭示了ICU病例量增加与住院死亡率降低之间的显著关联。特别是,急诊患者比例较高(>75%)的ICU表现出更明显的效果,在较高病例量四分位数（Q2，Q3和Q4）中住院死亡率的比值比为0.92（95％可信区间[CI]：0.88-0.96），0.70（95%CI：0.67-0.73），和0.78（95%CI：0.73-0.83），分别,与最低四分位数(Q1)相比。对于各种次要结果观察到类似的趋势。
结论：在主要治疗危重急诊患者的日本ICU中，较高的ICU病例量与较低的住院死亡率显著相关。这些发现强调了ICU专业化的重要性，并强调了集中护理对危重急诊患者的潜在益处。这些发现是改善日本医疗保健政策的潜在见解，并且可能在其他拥有类似医疗保健系统的国家的紧急护理环境中很有价值。在仔细考虑上下文差异之后。
