Key result
ICU patients discharged home experience ~90% two-year survival, with most deaths linked to discharge diagnoses.
Why the study?
The relationship between cause of death and hospital discharge diagnosis in intensive care patients within 2 years after discharge was unclear.
Cohort (n=1,984)
No
Survival rates of ICU patients after discharge are high, with deaths closely related to discharge diagnosis primarily in the first 6 months, and cancer being a common cause of death.
Post-ICU deaths often relate to discharge diagnosis, warranting closer surveillance; leaves open whether targeted follow-up improves survival.
OBJECTIVE: To identify intensive care patients dying within 2 years of discharge from hospital and assess whether the cause of death was related to the diagnosis at hospital discharge. DESIGN, SETTING AND PARTICIPANTS: A retrospective cohort study of all patients admitted to the intensive care unit at Wellington Hospital, New Zealand, between 1 July 2001 and 30 June 2003, using data from the ICU database. Mortality data were obtained from the New Zealand National Death Registry. MAIN OUTCOME MEASURES: Death within 2 years of hospital discharge; cause of death and its relation to the hospital discharge diagnosis. RESULTS: Of 1984 patients discharged home, 193 died within 2 years. One-year and 2-year survival rates were 93.8% and 90.3%, respectively. Two-year mortality rates were 4.6% in elective cardiac surgical patients, 19.7% in elective noncardiac surgical patients, 16.9% in acute patients admitted from the operating room, and 10.2% in other acute patients. Among the 193 patients who died after discharge, 124 deaths (64.2%) were related to the diagnosis at hospital discharge. The mortality rate in this group was highest at 3 months (90.5%) and lower at 6 months (75.0%), then averaged 51.4% after 6 months. Cause of death was related to discharge diagnosis in 46.2% of elective cardiac surgical patients, 66.6% of elective non-cardiac surgical patients, 60.5% of acute patients admitted from the operating room, and 75.4% of other acute patients. Cancer was the cause of death in 34.2% of elective cardiac surgical patients, 66.7% of elective non-cardiac surgical patients, 48.8% of acute patients admitted from the operating room, and 29.0% of other acute patients. CONCLUSION: Survival rates of ICU patients after discharge from hospital are high. Deaths are closely related to the discharge diagnosis only in the first 6 months after discharge. Cancer is a common cause of death. Elective non-cardiac surgical patients have the worst outcomes.
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Hicks et al. (2010) conducted a cohort in Intensive care patients (n=1,984). Intensive care unit admission and hospital discharge was evaluated on Death within 2 years of hospital discharge. Among 1,984 ICU patients discharged home, 2-year survival was 90.3%, with 64.2% of deaths related to the hospital discharge diagnosis.
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