Nighttime intensive care unit discharge and outcomes: A propensity matched retrospective cohort study

Thiago Domingos Corrêa, Carolina Rodrigues Ponzoni, Roberto Rabello Filho, Ary Serpa Neto, Renato Carneiro De Freitas Chaves, Andreia Pardini, Murillo Santucci Cesar Assunção, Guilherme De Paula Pinto Schettino, Danilo Teixeira Noritomi

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Abstract

Background Nighttime ICU discharge, i.e., discharge from the ICU during the night hours, has been associated with increased readmission rates, hospital length of stay (LOS) and in-hospital mortality. We sought to determine the frequency of nighttime ICU discharge and identify whether nighttime ICU discharge is associated with worse outcomes in a private adult ICU located in Brazil. Methods Post hoc analysis of a cohort study addressing the effect of ICU readmissions on outcomes. This retrospective, single center, propensity matched cohort study was conducted in a medical- surgical ICU located in a private tertiary care hospital in São Paulo, Brazil. Based on time of transfer, patients were categorized into nighttime (7:00 pm to 6:59 am) and daytime (7:00 am to 6:59 pm) ICU discharge and were propensity-score matched at a 1:2 ratio. The primary outcome of interest was in-hospital mortality. Results Among 4,313 eligible patients admitted to the ICU between June 2013 and May 2015, 1,934 patients were matched at 1:2 ratio [649 (33.6%) nighttime and 1,285 (66.4%) daytime discharged patients]. The median (IQR) cohort age was 66 (51-79) years and SAPS III score was 43 (33-55). In-hospital mortality was 6.5% (42/649) in nighttime compared to 5.6% (72/ 1,285) in daytime discharged patients (OR, 1.17; 95% CI, 0.79 to 1.73; p = 0.444). While frequency of ICU readmission (OR, 0.95; 95% CI, 0.78 to 1.29; p = 0.741) and length of hospital stay did not differ between the groups, length of ICU stay was lower in nighttime compared to daytime ICU discharged patients [1 (1-3) days vs. 2 (1-3) days, respectively, p = 0.047]. Conclusion In this propensity-matched retrospective cohort study, time of ICU discharge did not affect in-hospital mortality.

Original languageEnglish
Article numbere0207268
Number of pages13
JournalPLoS ONE
Volume13
Issue number12
DOIs
Publication statusPublished - 13 Dec 2018
Externally publishedYes

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