The timing of discharge from the intensive care unit and subsequent mortality. A prospective, multicenter study

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

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Abstract

Rationale: Previous studies suggested an association between afterhours intensive care unit (ICU) discharge and increased hospital mortality. Their retrospective design and lack of correction for patient factors present at the time of discharge make this association problematic. Objectives: To determine factors independently associated with mortality after ICU discharge. Methods: This was a prospective, multicenter, binational observational study involving 40 ICUs in Australia and New Zealand. Participants were consecutive adult patients discharged alive from the ICU between September 2009 and February 2010. Measurements and Main Results: We studied 10,211 patients discharged alive from the ICU. Median age was 63 years (interquartile range, 49-74), 6,224 (61 ) were male, 5,707 (56 ) required mechanical ventilation, and their median Acute Physiology and Chronic Health Evaluation III risk of death was 9 (interquartile range, 3-25 ). A total of 8,539 (83.6 ) patients were discharged inhours (06:00-18:00) and 1,672 (16.4 ) after-hours (18:00-06:00). Of these, 408 (4.8 ) and 124 (7.4 ), respectively, subsequently died in hospital (P,0.001). After risk adjustment for markers of illness severity at time of ICU discharge including limitations of medical therapy (LOMT) orders, the time of discharge was no longer a significant predictor of mortality. The presence of a LOMT order was the strongest predictor of death (odds ratio, 35.4; 95 confidence interval, 27.5-45.6). Conclusions: In this large, prospective, multicenter, binational observational study, we found that patient status at ICU discharge, particularly the presence of LOMT orders, was the chief predictor of hospital survival. In contrast to previous studies, the timing of discharge did not have an independent association with mortality.
Original languageEnglish
Pages (from-to)1033 - 1039
Number of pages7
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume191
Issue number9
DOIs
Publication statusPublished - 2015

Cite this

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title = "The timing of discharge from the intensive care unit and subsequent mortality. A prospective, multicenter study",
abstract = "Rationale: Previous studies suggested an association between afterhours intensive care unit (ICU) discharge and increased hospital mortality. Their retrospective design and lack of correction for patient factors present at the time of discharge make this association problematic. Objectives: To determine factors independently associated with mortality after ICU discharge. Methods: This was a prospective, multicenter, binational observational study involving 40 ICUs in Australia and New Zealand. Participants were consecutive adult patients discharged alive from the ICU between September 2009 and February 2010. Measurements and Main Results: We studied 10,211 patients discharged alive from the ICU. Median age was 63 years (interquartile range, 49-74), 6,224 (61 ) were male, 5,707 (56 ) required mechanical ventilation, and their median Acute Physiology and Chronic Health Evaluation III risk of death was 9 (interquartile range, 3-25 ). A total of 8,539 (83.6 ) patients were discharged inhours (06:00-18:00) and 1,672 (16.4 ) after-hours (18:00-06:00). Of these, 408 (4.8 ) and 124 (7.4 ), respectively, subsequently died in hospital (P,0.001). After risk adjustment for markers of illness severity at time of ICU discharge including limitations of medical therapy (LOMT) orders, the time of discharge was no longer a significant predictor of mortality. The presence of a LOMT order was the strongest predictor of death (odds ratio, 35.4; 95 confidence interval, 27.5-45.6). Conclusions: In this large, prospective, multicenter, binational observational study, we found that patient status at ICU discharge, particularly the presence of LOMT orders, was the chief predictor of hospital survival. In contrast to previous studies, the timing of discharge did not have an independent association with mortality.",
author = "John Santamaria and Duke, {Graeme J} and Pilcher, {David V} and Cooper, {David James} and Moran, {John L} and Rinaldo Bellomo",
year = "2015",
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volume = "191",
pages = "1033 -- 1039",
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The timing of discharge from the intensive care unit and subsequent mortality. A prospective, multicenter study. / Santamaria, John; Duke, Graeme J; Pilcher, David V; Cooper, David James; Moran, John L; Bellomo, Rinaldo.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 191, No. 9, 2015, p. 1033 - 1039.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - The timing of discharge from the intensive care unit and subsequent mortality. A prospective, multicenter study

AU - Santamaria, John

AU - Duke, Graeme J

AU - Pilcher, David V

AU - Cooper, David James

AU - Moran, John L

AU - Bellomo, Rinaldo

PY - 2015

Y1 - 2015

N2 - Rationale: Previous studies suggested an association between afterhours intensive care unit (ICU) discharge and increased hospital mortality. Their retrospective design and lack of correction for patient factors present at the time of discharge make this association problematic. Objectives: To determine factors independently associated with mortality after ICU discharge. Methods: This was a prospective, multicenter, binational observational study involving 40 ICUs in Australia and New Zealand. Participants were consecutive adult patients discharged alive from the ICU between September 2009 and February 2010. Measurements and Main Results: We studied 10,211 patients discharged alive from the ICU. Median age was 63 years (interquartile range, 49-74), 6,224 (61 ) were male, 5,707 (56 ) required mechanical ventilation, and their median Acute Physiology and Chronic Health Evaluation III risk of death was 9 (interquartile range, 3-25 ). A total of 8,539 (83.6 ) patients were discharged inhours (06:00-18:00) and 1,672 (16.4 ) after-hours (18:00-06:00). Of these, 408 (4.8 ) and 124 (7.4 ), respectively, subsequently died in hospital (P,0.001). After risk adjustment for markers of illness severity at time of ICU discharge including limitations of medical therapy (LOMT) orders, the time of discharge was no longer a significant predictor of mortality. The presence of a LOMT order was the strongest predictor of death (odds ratio, 35.4; 95 confidence interval, 27.5-45.6). Conclusions: In this large, prospective, multicenter, binational observational study, we found that patient status at ICU discharge, particularly the presence of LOMT orders, was the chief predictor of hospital survival. In contrast to previous studies, the timing of discharge did not have an independent association with mortality.

AB - Rationale: Previous studies suggested an association between afterhours intensive care unit (ICU) discharge and increased hospital mortality. Their retrospective design and lack of correction for patient factors present at the time of discharge make this association problematic. Objectives: To determine factors independently associated with mortality after ICU discharge. Methods: This was a prospective, multicenter, binational observational study involving 40 ICUs in Australia and New Zealand. Participants were consecutive adult patients discharged alive from the ICU between September 2009 and February 2010. Measurements and Main Results: We studied 10,211 patients discharged alive from the ICU. Median age was 63 years (interquartile range, 49-74), 6,224 (61 ) were male, 5,707 (56 ) required mechanical ventilation, and their median Acute Physiology and Chronic Health Evaluation III risk of death was 9 (interquartile range, 3-25 ). A total of 8,539 (83.6 ) patients were discharged inhours (06:00-18:00) and 1,672 (16.4 ) after-hours (18:00-06:00). Of these, 408 (4.8 ) and 124 (7.4 ), respectively, subsequently died in hospital (P,0.001). After risk adjustment for markers of illness severity at time of ICU discharge including limitations of medical therapy (LOMT) orders, the time of discharge was no longer a significant predictor of mortality. The presence of a LOMT order was the strongest predictor of death (odds ratio, 35.4; 95 confidence interval, 27.5-45.6). Conclusions: In this large, prospective, multicenter, binational observational study, we found that patient status at ICU discharge, particularly the presence of LOMT orders, was the chief predictor of hospital survival. In contrast to previous studies, the timing of discharge did not have an independent association with mortality.

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U2 - 10.1164/rccm.201412-2208OC

DO - 10.1164/rccm.201412-2208OC

M3 - Article

VL - 191

SP - 1033

EP - 1039

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

SN - 1073-449X

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