Readmissions to Intensive Care

A Prospective Multicenter Study in Australia and New Zealand

John D. Santamaria, Graeme J Duke, David V. Pilcher, D. James Cooper, John L Moran, Rinaldo Bellomo

Research output: Contribution to journalArticleResearchpeer-review

9 Citations (Scopus)

Abstract

OBJECTIVES:: To determine factors independently associated with readmission to ICU and the independent association of readmission with subsequent mortality. DESIGN:: Prospective multicenter observational study. SETTING:: Forty ICUs in Australia and New Zealand. PATIENTS:: Consecutive adult patients discharged alive from ICU to hospital wards between September 2009 and February 2010. INTERVENTIONS:: Measurement of hospital mortality. MEASUREMENTS AND MAIN RESULTS:: We studied 10,210 patients and 674 readmissions. The median age was 63 years (interquartile range, 49–74), and 6,224 (61%) were male. The majority of readmissions were unplanned (84.1%) but only deemed preventable in a minority (8.9%) of cases. Time to first readmission was shorter for unplanned than planned readmission (3.2 vs 6.9 d; p < 0.001). Primary diagnosis changed between admission and readmission in the majority of patients (60.2%) irrespective of planned (58.2%) or unplanned (60.6%) status. Using recurrent event analysis incorporating patient frailty, we found no association between readmissions and hospital survival (hazard ratios: first readmission 0.88, second readmission 0.90, third readmission 0.44; p > 0.05). In contrast, age (hazard ratio, 1.03), a medical diagnosis (hazard ratio, 1.43), inotrope use (hazard ratio, 3.47), and treatment limitation order (hazard ratio, 17.8) were all independently associated with outcome. CONCLUSIONS:: In this large prospective study, readmission to ICU was not an independent risk factor for mortality.

Original languageEnglish
Pages (from-to)290-297
Number of pages8
JournalCritical Care Medicine
Volume45
Issue number2
DOIs
Publication statusPublished - 1 Feb 2017

Cite this

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title = "Readmissions to Intensive Care: A Prospective Multicenter Study in Australia and New Zealand",
abstract = "OBJECTIVES:: To determine factors independently associated with readmission to ICU and the independent association of readmission with subsequent mortality. DESIGN:: Prospective multicenter observational study. SETTING:: Forty ICUs in Australia and New Zealand. PATIENTS:: Consecutive adult patients discharged alive from ICU to hospital wards between September 2009 and February 2010. INTERVENTIONS:: Measurement of hospital mortality. MEASUREMENTS AND MAIN RESULTS:: We studied 10,210 patients and 674 readmissions. The median age was 63 years (interquartile range, 49–74), and 6,224 (61{\%}) were male. The majority of readmissions were unplanned (84.1{\%}) but only deemed preventable in a minority (8.9{\%}) of cases. Time to first readmission was shorter for unplanned than planned readmission (3.2 vs 6.9 d; p < 0.001). Primary diagnosis changed between admission and readmission in the majority of patients (60.2{\%}) irrespective of planned (58.2{\%}) or unplanned (60.6{\%}) status. Using recurrent event analysis incorporating patient frailty, we found no association between readmissions and hospital survival (hazard ratios: first readmission 0.88, second readmission 0.90, third readmission 0.44; p > 0.05). In contrast, age (hazard ratio, 1.03), a medical diagnosis (hazard ratio, 1.43), inotrope use (hazard ratio, 3.47), and treatment limitation order (hazard ratio, 17.8) were all independently associated with outcome. CONCLUSIONS:: In this large prospective study, readmission to ICU was not an independent risk factor for mortality.",
author = "Santamaria, {John D.} and Duke, {Graeme J} and Pilcher, {David V.} and Cooper, {D. James} and Moran, {John L} and Rinaldo Bellomo",
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Readmissions to Intensive Care : A Prospective Multicenter Study in Australia and New Zealand. / Santamaria, John D.; Duke, Graeme J; Pilcher, David V.; Cooper, D. James; Moran, John L; Bellomo, Rinaldo.

In: Critical Care Medicine, Vol. 45, No. 2, 01.02.2017, p. 290-297.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Readmissions to Intensive Care

T2 - A Prospective Multicenter Study in Australia and New Zealand

AU - Santamaria, John D.

AU - Duke, Graeme J

AU - Pilcher, David V.

AU - Cooper, D. James

AU - Moran, John L

AU - Bellomo, Rinaldo

PY - 2017/2/1

Y1 - 2017/2/1

N2 - OBJECTIVES:: To determine factors independently associated with readmission to ICU and the independent association of readmission with subsequent mortality. DESIGN:: Prospective multicenter observational study. SETTING:: Forty ICUs in Australia and New Zealand. PATIENTS:: Consecutive adult patients discharged alive from ICU to hospital wards between September 2009 and February 2010. INTERVENTIONS:: Measurement of hospital mortality. MEASUREMENTS AND MAIN RESULTS:: We studied 10,210 patients and 674 readmissions. The median age was 63 years (interquartile range, 49–74), and 6,224 (61%) were male. The majority of readmissions were unplanned (84.1%) but only deemed preventable in a minority (8.9%) of cases. Time to first readmission was shorter for unplanned than planned readmission (3.2 vs 6.9 d; p < 0.001). Primary diagnosis changed between admission and readmission in the majority of patients (60.2%) irrespective of planned (58.2%) or unplanned (60.6%) status. Using recurrent event analysis incorporating patient frailty, we found no association between readmissions and hospital survival (hazard ratios: first readmission 0.88, second readmission 0.90, third readmission 0.44; p > 0.05). In contrast, age (hazard ratio, 1.03), a medical diagnosis (hazard ratio, 1.43), inotrope use (hazard ratio, 3.47), and treatment limitation order (hazard ratio, 17.8) were all independently associated with outcome. CONCLUSIONS:: In this large prospective study, readmission to ICU was not an independent risk factor for mortality.

AB - OBJECTIVES:: To determine factors independently associated with readmission to ICU and the independent association of readmission with subsequent mortality. DESIGN:: Prospective multicenter observational study. SETTING:: Forty ICUs in Australia and New Zealand. PATIENTS:: Consecutive adult patients discharged alive from ICU to hospital wards between September 2009 and February 2010. INTERVENTIONS:: Measurement of hospital mortality. MEASUREMENTS AND MAIN RESULTS:: We studied 10,210 patients and 674 readmissions. The median age was 63 years (interquartile range, 49–74), and 6,224 (61%) were male. The majority of readmissions were unplanned (84.1%) but only deemed preventable in a minority (8.9%) of cases. Time to first readmission was shorter for unplanned than planned readmission (3.2 vs 6.9 d; p < 0.001). Primary diagnosis changed between admission and readmission in the majority of patients (60.2%) irrespective of planned (58.2%) or unplanned (60.6%) status. Using recurrent event analysis incorporating patient frailty, we found no association between readmissions and hospital survival (hazard ratios: first readmission 0.88, second readmission 0.90, third readmission 0.44; p > 0.05). In contrast, age (hazard ratio, 1.03), a medical diagnosis (hazard ratio, 1.43), inotrope use (hazard ratio, 3.47), and treatment limitation order (hazard ratio, 17.8) were all independently associated with outcome. CONCLUSIONS:: In this large prospective study, readmission to ICU was not an independent risk factor for mortality.

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U2 - 10.1097/CCM.0000000000002066

DO - 10.1097/CCM.0000000000002066

M3 - Article

VL - 45

SP - 290

EP - 297

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 2

ER -