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Objective: To determine if having a night-time nurse-to-patient ratio (NNPR) of one nurse caring for one or two patients (>1:2) versus one nurse caring for three or more patients (<1:2) in the intensive care unit (ICU) is associated with clinical and economic outcomes following esophageal resection. Design: Statewide observational cohort study. Hospital discharge data was linked to a prospective survey of ICU organizational characteristics. Multivariate analysis adjusting for case-mix, hospital and surgeon volume was used to determine the association of NNPR with in-hospital mortality, length of stay (LOS), hospital cost and specific postoperative complications. Setting: Non-federal acute care hospitals (n=35) in Maryland that performed esophageal resection. Patients and participants: Adult patients who had esophageal resection in Maryland, 1994 to 1998 (n=366 patients). Measurements and …