Impact of hospital sepsis case volume on mortality in sepsis patients: a meta-analysis

Objective Evidence regarding the impact of annual hospital sepsis case volume on clinical outcomes in patients with sepsis remains controversial. This study aimed to conduct a meta-analysis to evaluate the potential association between annual sepsis case volume and mortality among patients with sepsis. Methods A comprehensive electronic search was performed in PubMed, Web of Science, Embase, and Cochrane Library databases. Mean differences (MDs) or odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using Review Manager 5.3. Results A total of 4,408,416 patients from 18 studies were included in this meta-analysis, comprising 1,828,689 patients treated in high-volume hospitals and 2,579,727 patients treated in low-volume hospitals. Compared with low-volume hospitals, treatment in high-volume hospitals was associated with significantly lower in-hospital mortality [OR = 0.90 (95% CI: 0.87–0.93, P < 0.00001)], ICU mortality [OR = 0.93 (95% CI: 0.91–0.94, P < 0.00001)], and early mortality [OR = 0.81 (95% CI: 0.76–0.87, P < 0.00001)], as well as a significantly shorter ICU length of stay [MD = −0.11 days (95% CI: −0.22 to −0.01, P = 0.04)]. However, no significant difference was observed in hospital length of stay between high- and low-volume hospitals. Conclusions Hospitals with a high annual sepsis case volume are associated with reduced mortality among patients with sepsis. Future studies are warranted to further define clinically meaningful thresholds for high-volume hospitals.