Five Year Mortality and Hospital Costs Associated With Surviving Intensive Care.
Am J Respir Crit Care Med. 2016 Jan 27;
Authors: Lone NI, Gillies MA, Haddow C, Dobbie R, Rowan KM, Wild SH, Murray GD, Walsh TS
Abstract
Rationale Survivors of critical illness experience significant morbidity, but the impact of surviving ICU has not been quantified comprehensively at a population level. Objectives To identify factors associated with increased hospital resource use and to ascertain if ICU admission was associated with increased mortality and resource use. Methods Matched cohort study and pre-post analysis using national linked data registries with complete population coverage.
POPULATION: patients admitted to all adult general ICUs during 2005 surviving to hospital discharge identified from the Scottish Intensive Care Society Audit Group (SICSAG) registry; matched (1:1) to similar hospital controls. Five-year outcomes: mortality, hospital resource use. Confounder adjustment: multivariable regression and pre-post within-individual analyses. Measurements and Main results 5259 from 7656 ICU patients survived to hospital discharge (5215(99.2%) matched to hospital controls). Factors present pre-ICU admission (comorbidities/pre-ICU hospitalisations) were stronger predictors of hospital resource use than acute illness factors. In the five years after the initial hospital discharge compared with hospital controls, the ICU cohort had higher mortality (32.3% versus 22.7%, hazard ratio 1.33,95%CI 1.22 to 1.46,p<0.001), used more hospital resources (mean hospital admission rate 4.8 versus 3.3/person/5years) and had 51% higher mean five-year hospital costs ($25608 versus $16913/patient). Increased resource use persisted after confounder adjustment (p<0.001) and using pre-post analyses (p<0.001). Excess resource use and mortality was greatest for younger patients without significant comorbidity. Conclusions This complete, national study demonstrates that ICU survivorship is associated with higher five-year mortality and hospital resource utilisation than hospital controls representing a substantial burden on individuals, care-givers and society.
PMID: 26815887 [PubMed - as supplied by publisher]