Long-Term Outcomes and Health Care Utilization after Prolonged Mechanical Ventilation

RATIONALE: Limited data are available to characterize the long-term outcomes and associated costs for patients who require prolonged mechanical ventilation (PMV; defined here as mechanical ventilation for longer than 21 d). OBJECTIVES: To examine the association between PMV and mortality, health care utilization, and costs after critical illness. METHODS: Population-based cohort study of adults who received mechanical ventilation in an intensive care unit (ICU) in Ontario, Canada between 2002 and 2013. MEASUREMENT AND MAIN RESULTS: We used linked administrative databases to determine discharge disposition, and ascertain 1-year mortality (primary outcome), readmissions to hospital and ICU, and health care costs for hospital survivors. Overall, 11, 594 (5. 4%) patients underwent PMV, with 42. 4% of patients dying in the hospital (vs. 27. 6% of patients who did not undergo prolonged ventilation; P < 0. 0001). Patients on prolonged ventilation were more frequently discharged to other facilities or home with health care support (84. 8 vs. 43. 5%, P < 0. 0001). Among hospital survivors, estimated mortality was higher for patients who underwent PMV: 16. 6 versus 11% at 1 year and 42. 0 versus 30. 4% at 5 years. At 1 year after hospital discharge, patients on prolonged ventilation had higher rates of hospital readmission (47. 2 vs. 37. 7%; adjusted odds ratio = 1. 20; 95% confidence interval = 1. 14-1. 26), ICU readmission (19. 0 vs. 11. 6%; adjusted odds ratio = 1. 49; 95% confidence interval: 1. 39, 1. 60), and total health care costs: median (interquartile range) Can 32, 526 (20, 821-56, 102) versus Can 13, 657 (5, 946-38, 022). Increasing duration of mechanical ventilation was associated with higher mortality and health care utilization. CONCLUSIONS: Critically ill patients who undergo mechanical ventilation in an ICU for longer than 21 days have high in-hospital mortality and greater postdischarge mortality, health care utilization, and health care costs compared with patients who undergo mechanical ventilation for a shorter period of time.