November 1, 2012
View Full PaperPatients’ Characteristics Associated With Readmission to a Surgical Intensive Care Unit
Key Result
Readmission to a surgical intensive care unit occurred in 8% of patients and was independently associated with type of admission, need for mechanical ventilation, and higher severity of illness.
Study Design
Type
Cohort (n=1,682)
Structured PICO
What patient characteristics are associated with readmission to a surgical intensive care unit, and how does readmission affect long-term survival and quality of life?
P
Population
1,682 patients discharged alive from a surgical intensive care unit between 1995 and 2000, followed for a mean of 8 years.
C
Comparator
Patients not readmitted to the surgical intensive care unit
O
Outcome
Variables associated with readmission, long-term survival, and quality of life (measured with EuroQol-6D)hard clinical
Readmission to a surgical ICU is associated with higher initial severity of illness and mechanical ventilation, leading to worse long-term survival but no significant difference in quality of life among survivors.
Abstract
BACKGROUND: Readmission within 48 hours is a leading performance indicator of the quality of care in an intensive care unit. OBJECTIVE: To investigate variables that might be associated with readmission to a surgical intensive care unit. METHODS: Demographic characteristics, severity-of-illness scores, and survival rates were collected for all patients admitted to a surgical intensive care unit between 1995 and 2000. Long-term survival and quality of life were determined for patients who were readmitted within 30 days after discharge from the unit. Quality of life was measured with the EuroQol-6D questionnaire. Multivariate logistic analysis was used to calculate the independent association of expected covariates. RESULTS: Mean follow-up time was 8 years. Of the 1682 patients alive at discharge, 141 (8%) were readmitted. The main causes of readmission were respiratory decompensation (48%) and cardiac conditions (16%). Compared with the total sample, patients readmitted were older, mostly had vascular (39%) or gastrointestinal (26%) disease, and had significantly higher initial severity of illness (P = .003, .007) and significantly more comorbid conditions (P = .005). For all surgical classifications except general surgery, readmission was independently associated with type of admission and need for mechanical ventilation. Long-term mortality was higher among patients who were readmitted than among the total sample. Nevertheless, quality-of-life scores were the same for patients who were readmitted and patients who were not. CONCLUSION: The adverse effect of readmission to the intensive care unit on survival appears to be long-lasting, and predictors of readmission are scarce.