Analysis of Readmissions to Neurosurgery Intensive Care Unit

Background. Around 10% of patients in developed coun­tries are readmitted to the Intensive care unit during the same hospitalisation each year [1,2]. Readmission is as­sociated with increased length of stay, risk of morbidity and mortality and higher hospital costs [1,3]. Finding out the factors increasing the risk of readmission is es­sential to predict which patients will return to the ICU. Aim. To analyse the incidence and causes of readmissions to the NICU and to assess the impact of readmissions on patients’ outcomes. Methods. A retrospective single-center chart review of 90 patients readmited to the Neurosurgery intensive care unit (NICU) of the Hospital of Lithuanian University of Health Sciences (LUHS) “Kaunas Clinics“ from January 1st to December 31st of 2020, was performed. Demografic and clinical variables such as: admission diagnosis, tim­ing and indications for readmissions, length of NICU stay during readmission, presence of infection, the need for vasopressors and mechanical ventilation (MV) were assessed. Results. 1598 patients were admitted to the NICU in 2020. 90 case histories of readmitted patients were an­alyzed. Patients were divided into survivors and non-survivors groups. 46 (51.50%) of patients were males, the average age was 63.68 (SD 15.89) years. Most fre­quent indications for readmission were respiratory failure (25.56%), reoperation (24.44%), neurological reasons (21.11%, e.g. decreased state of consciousness, status epilepticus). The readmission rate was 5.63%. The mor­tality rate of readmitted patients was 22.50% (the overall mortality in the NICU in 2020 – 10.40%). Presence of nosocomial infection and MV were associated with lon­ger length of stay in the NICU (p < 0.05). Higher mor­tality was related to worse state of consciousness at the time of readmission to the NICU, presence of nosocomial infection, need for vasopressors and/or MV (p < 0.05). Conclusions. The rate of readmission to the NICU was 5.63%. The most common causes for readmission to the NICU were: respiratory failure, reoperation, and neuro­logical indications. The mortality rate of patients that were readmitted to the NICU was higher than overall mortality. Respiratory failure, the need for vasopressors, mechanical ventilation, and hospital-acquired infection were related to worse outcomes.