Key result
Critical care survival improves over 16 years despite increasing severity, particularly among cardiac surgery patients.
Why the study?
The characteristics of critically ill patients and their effect on long-term outcomes over time were not well characterized in an Australian tertiary ICU.
Cohort (n=22,298)
No
Long-term survival of critically ill patients has improved over a 16-year period despite an increasingly older and sicker case-mix, suggesting ongoing cost-effectiveness of critical care.
Patient characteristics shifts may influence ICU long-term survival; leaves open whether updated risk models are needed in evolving populations.
Critical care service is expensive and the demand for such service is increasing in many developed countries. This study aimed to assess the changes in characteristics of critically ill patients and their effect on long-term outcome. This cohort study utilised linked data between the intensive care unit database and state-wide morbidity and mortality databases. Logistic and Cox regression was used to examine hospital survival and five-year survival of 22,298 intensive care unit patients, respectively. There was a significant increase in age, severity of illness and Charlson Comorbidity Index of the patients over a 16-year study period. Although hospital mortality and median length of intensive care unit and hospital stay remained unchanged, one- and five-year survival had significantly improved with time, after adjusting for age, gender; severity of illness, organ failure, comorbidity, 'new' cancer and diagnostic group. Stratified analyses showed that the improvement in five-year survival was particularly strong among patients admitted after cardiac surgery (P = 0.001). In conclusion, although critical care service is increasingly being provided to patients with a higher severity of acute and chronic illnesses, long-term survival outcome has improved with time suggesting that critical care service may still be cost-effectiveness despite the changes in case-mix.
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Williams et al. (2010) conducted a cohort in Critically ill patients (n=22,298). Admission over a 16-year study period vs. Earlier admission periods was evaluated on Hospital survival and five-year survival. One- and five-year survival of critically ill patients significantly improved over a 16-year period despite increasing age and illness severity, particularly among cardiac surgery patients (P=0.001).
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