Impact of hospital volume on in-hospital outcomes for patients undergoing extracorporeal membrane oxygenation post-cardiac surgery: Evidence from nationwide inpatient sample

Abstract

Objective:

This study aimed to determine the impact of hospitals’ extracorporeal membrane oxygenation (ECMO) procedure volume on inpatient outcomes in patients receiving ECMO after cardiac surgery.

Methods:

The records of patients in the United States Nationwide Inpatient Sample database ⩾18 years old who underwent cardiac surgery and received ECMO postoperatively from 2005 to 2020 were retrospectively analyzed. Associations between hospital ECMO volume, demographical and clinical variables, and in-hospital mortality, non-routine discharge, hospital costs, acute organ failure, and infection/sepsis were examined.

Results:

Data of 1465 patients hospitalized in 892 hospitals were analyzed. There were 102 high ECMO-volume hospitals and 790 low ECMO-volume hospitals. Patients treated in high ECMO-volume hospitals (n = 317) had a significantly decreased risk of in-hospital mortality (adjusted OR (aOR) = 0.69, 95% confidence interval (CI): 0.51–0.94) compared to those treated in low ECMO-volume hospitals (n = 1148). In contrast, patients treated in high-volume hospitals had a significantly increased risk of non-routine discharge (aOR = 1.52, 95% CI: 1.03–2.25, p = 0.034) than those who stayed in the low-volume hospitals.

Conclusions:

High hospital ECMO volume is associated with a lower risk of in-hospital death among patients receiving ECMO after cardiac surgeries, indicating the need for policies that guide patient referrals to institutions with more extensive ECMO experience.