ICUThe effect of comorbidities on risk of intensive care readmission during the same hospitalization: A linked data cohort study,☆,☆☆
Section snippets
Study population
This cohort study used the clinical database of the tertiary ICU at Royal Perth Hospital (RPH) in Western Australia. The 22-bed tertiary ICU is a ‘closed’ ICU with a dedicated team of intensivists and admits critically ill adult patients of all specialties except liver transplantation. Patients were discharged from the ICU to the ward if they were deemed to be stable enough to be managed by a lower intensity of nursing care (ie, 1 nurse to 4 or more patients). Some ICU patients were discharged
Results
There were 16 926 consecutive ICU admissions between 1987 and 2002, and of these, 654 (3.9%) were readmitted to the ICU during the same hospitalization. There were 274 early (≤72 hours of discharge) and 380 late (>72 hours of discharge) ICU readmissions. The distribution of the time interval between ICU discharge and readmission is described in Fig. 1.
The mean age, length of ICU stay, and length of the hospital stay of the whole cohort was 53.9 years (standard deviation [SD] = 19.3), 4.9 days
Discussion
Our results show that there were significant differences in clinical characteristics between patients with and without ICU readmission. Comorbidity, as measured by the number of Charlson comorbidities, was a significant risk factor for late (>72 hours) ICU readmission after adjusting for age, admission source, type of admission, and the APACHE-predicted mortality. However, comorbidities could not account for the excess mortality associated with ICU readmissions.
Most risk adjustment tools
Acknowledgment
We would like to thank Dr Geoffrey Clarke and Dr John Weekes for their part in initiating the RPH ICU database and also all ICU consultants who have been recording APACHE II data for every admission to the ICU of RPH.
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This study was performed and funded by the Department of Intensive Care, Royal Perth Hospital.
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None of the authors have any involvement with organization(s) with financial interest in the subject matter of this study.