TY - JOUR T1 - Procedure volume is one determinant of centre effect in mechanically ventilated patients JF - European Respiratory Journal JO - Eur Respir J SP - 364 LP - 370 DO - 10.1183/09031936.00195209 VL - 37 IS - 2 AU - M. Darmon AU - E. Azoulay AU - J-P. Fulgencio AU - B. Garrigues AU - C. Gouzes AU - P. Moine AU - D. Villers AU - V. Teboul AU - J-R. le Gall AU - S. Chevret Y1 - 2011/02/01 UR - http://erj.ersjournals.com/content/37/2/364.abstract N2 - Survival rates vary significantly between intensive care units, most notably in patients requiring mechanical ventilation (MV). The present study sought to estimate the effect of hospital MV volume on hospital mortality. We included 179,197 consecutive patients who received mechanical ventilation in 294 hospitals. Multivariate logistic regression models with random intercepts were used to estimate the effect of annual MV volume in each hospital, adjusting for differences in severity of illness and case mix. Median annual MV volume was 162 patients (interquartile range 99–282). Hospital mortality in MV patients was 31.4% overall, 40.8% in the lowest annual volume quartile and 28.2% in the highest quartile. After adjustment for severity of illness, age, diagnosis and organ failure, higher MV volume was associated with significantly lower hospital mortality among MV patients (OR 0.9985 per 10 additional patients, 95% CI 0.9978–0.9992; p = 0.0001). A significant centre effect on hospital mortality persisted after adjustment for volume effect (p<0.0001). Our study demonstrated higher hospital MV volume to be independently associated with increased survival among MV patients. Significant differences in outcomes persisted between centres after adjustment for hospital MV volume, supporting a role for other significant determinants of the centre effect. ER -