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Impact of annual hospital volume of high dose interleukin-2 infusions on in-patient mortality in patients with melanoma and renal cell carcinoma
© Mehta et al. 2015
Published: 4 November 2015
The 2014 expert consensus on high dose interleukin-2 (HD-IL-2) states that, “Treating a minimum number of patients per year is important, as quality depends upon familiarity and repetition” . The minimum annual volume of HD-IL-2 associated with relatively worse outcomes is not known.
We analyzed the National Inpatient Sample (NIS), one of the largest publicly-available in-patient dataset in United States (U.S.), which represents a 20% stratified random sample of discharges from all hospitals. The NIS is drawn from all States participating in Healthcare Cost and Utilization Project, and thus represents 95 percent of the U.S. population. Patients with melanoma and renal cell carcinoma (RCC) were identified by using the ICD9 diagnostic codes. From this sample, patients receiving HD-IL-2 were identified by ICD9 procedure code 00.15. Annual hospital volume was calculated using a unique hospital number, available in the dataset. Using Joinpoint regression analysis, which detects change in trend of in-patient mortality with change in annual hospital volume, the hospitals were classified in 3 volume categories (low, medium and high). Multivariate logistic regression was used to identify predictors of in-patient mortality controlling for confounders including age, sex, Charlson comorbidity index, RCC, calendar year, urban location and teaching status of hospital.
Lower annual hospital volume of HD-IL-2 is associated with higher HD-IL2 related in-patient mortality. Annual hospital volume of less than 20 treatments is associated with 9 time higher risk of in-patient mortality as compared to high volume hospitals.
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