Lower Mortality for Abdominal Aortic Aneurysm Repair in High-Volume Hospitals Is Contingent upon Nurse Staffing
Article first published online: 22 OCT 2012
© Health Research and Educational Trust
Health Services Research
Volume 48, Issue 3, pages 972–991, June 2013
How to Cite
Wiltse Nicely, K. L., Sloane, D. M. and Aiken, L. H. (2013), Lower Mortality for Abdominal Aortic Aneurysm Repair in High-Volume Hospitals Is Contingent upon Nurse Staffing. Health Services Research, 48: 972–991. doi: 10.1111/1475-6773.12004
- Issue published online: 9 MAY 2013
- Article first published online: 22 OCT 2012
- National Institute of Nursing Research, National Institutes of Health. Grant Numbers: R01-NR-004513, T32-NR-007104
- Nurse staffing;
- nurse practice environment;
- abdominal aortic aneurysm
To determine whether and to what extent the lower mortality rates for patients undergoing abdominal aortic aneurysm (AAA) repair in high-volume hospitals is explained by better nursing.
State hospital discharge data, Multi-State Nursing Care and Patient Safety Survey, and hospital characteristics from the AHA Annual Survey.
Cross-sectional analysis of linked patient outcomes for individuals undergoing AAA repair in four states.
Secondary data sources.
Favorable nursing practice environments and higher hospital volumes of AAA repair are associated with lower mortality and fewer failures-to-rescue in main-effects models. Furthermore, nurse staffing interacts with volume such that there is no mortality advantage observed in high-volume hospitals with poor nurse staffing. When hospitals have good nurse staffing, patients in low-volume hospitals are 3.4 times as likely to die and 2.6 times as likely to die from complications as patients in high-volume hospitals (p < .001).
Nursing is part of the explanation for lower mortality after AAA repair in high-volume hospitals. Importantly, lower mortality is not found in high-volume hospitals if nurse staffing is poor.