Hospital Volume and Mortality of Very Low-Birthweight Infants in South America
Article first published online: 21 FEB 2012
© Health Research and Educational Trust
Health Services Research
Volume 47, Issue 4, pages 1502–1521, August 2012
How to Cite
Wehby, G. L., Lopez-Camelo, J. and Castilla, E. E. (2012), Hospital Volume and Mortality of Very Low-Birthweight Infants in South America. Health Services Research, 47: 1502–1521. doi: 10.1111/j.1475-6773.2012.01383.x
- Issue published online: 5 JUL 2012
- Article first published online: 21 FEB 2012
- NIH. Grant Numbers: 1R03 n, 5R03 TW 008110
- Child and adolescent health;
- maternal and perinatal care and outcomes;
- referrals and referral networks;
- quality of care/patient safety (measurement);
To assess the effects of hospital volume of very low-birthweight (VLBW) infants on in-hospital mortality of VLBW and very preterm birth (VPB) infants in South America.
Data Sources/Study Setting
Birth-registry data for infants born in 1982–2008 at VLBW or very preterm in 66 hospitals in Argentina, Brazil, and Chile.
Regression analyses that adjust for several individual-level demographic, socioeconomic, and health factors; hospital-level characteristics; and country-fixed effects are employed.
Data Collection/Extraction Methods
Physicians interviewed mothers before hospital discharge and abstracted hospital medical records using similar methods at all hospitals.
Volume has significant nonlinear beneficial effects on VLBW and VPB in-hospital survival. The largest survival benefits––more than 80 percent decrease in mortality rates––are with volume increases from low to medium or medium-high levels (from ≤25 to 72 infants annually) with significantly lower incremental benefits thereafter. The cumulative volume effects are maximized at the 121–144 annual VLBW infant range––about 90 percent decrease in mortality rates compared to <25 VLBW infants annually.
Increasing the access of pregnancies at-risk of VLBW and VPB to medium- or high-volume hospitals up to 144 VLBW infants per year may substantially improve in-hospital infant survival in the study countries.