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 language | English |
|---|---|
| Pages (from-to) | 290-297 |
| Number of pages | 8 |
| Journal | Critical Care Medicine |
| Volume | 45 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 1 Feb 2017 |
Cite this
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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 journal › Article › Research › peer-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.
UR - http://www.scopus.com/inward/record.url?scp=84987926209&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000002066
DO - 10.1097/CCM.0000000000002066
M3 - Article
AN - SCOPUS:84987926209
VL - 45
SP - 290
EP - 297
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 2
ER -