Predictors of early postdischarge mortality in critically ill patients: A retrospective cohort study from the California Intensive Care Outcomes project

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• 作者：Eduard E. Vasilevskis MD^a ; ^b ; ^c ; ^h ; ⁱ ; ^j ; ^{eduard.vasilevskis@vanderbilt.edu} ; Michael W. Kuzniewicz MD ; MPH^a ; ^d ; Brian A. Cason MD^e ; ^g ; Rondall K. Lane MD ; MPH^a ; ^e ; Mitzi L. Dean MS ; MHA^a ; Ted Clay MS^a ; Deborah J. Rennie BA^a ; R. Adams Dudley MD ; MBA^a ; ^f
• 关键词：Intensive care unit ; Hospital mortality ; Patient discharge ; Outcome assessment (Health care) ; Health services research ; Transitions of Care
• 刊名：Journal of Critical Care
• 出版年：2011
• 出版时间：February 2011
• 年：2011
• 卷：26
• 期：1
• 页码：65-75
• 全文大小：297 K

文摘

Purpose

Existing intensive care unit (ICU) mortality measurement systems address in-hospital mortality only. However, early postdischarge mortality contributes significantly to overall 30-day mortality. Factors associated with early postdischarge mortality are unknown.

Methods

We performed a retrospective study of 8484 ICU patients. Our primary outcome was early postdischarge mortality: death after hospital discharge and 30 days or less from ICU admission. Cox regression models assessed the association between patient, hospital, and utilization factors and the primary outcome.

Results

In multivariate analyses, the hazard for early postdischarge mortality increased with rising severity of illness and decreased with full-code status (hazard ratio [HR], 0.33; 95 % confidence interval [CI], 0.21-0.49). Compared with discharges home, early postdischarge mortality was highest for acute care transfers (HR, 3.18; 95 % CI, 2.45-4.12). Finally, patients with very short ICU length of stay (<1 day) had greater early postdischarge mortality (HR, 1.86; 95 % CI; 1.32-2.61) than those with longest stays (≥7 days).

Conclusions

Early postdischarge mortality is associated with patient preferences (full-code status) and decisions regarding timing and location of discharge. These findings have important implications for anyone attempting to measure or improve ICU performance and who rely on in-hospital mortality measures to do so.