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Abstract
BACKGROUND: Quantification of long-term survival, health care utilization, and costs of prolonged ventilator dependence informs patient/family decision-making, health care policy, and understanding of specialized weaning centers (SWCs) as alternate care models. Our objective was to compare survival trajectory, health care utilization, and costs of SWC survivors with a matched cohort of ≥ 21-d-stay ICU patients.
METHODS: This was a retrospective longitudinal (12 y) case-control study linking to health administrative databases with matching on age, sex, Charlson comorbidity index, income quintiles, and days in ICU and hospital in preceding 12 months.
RESULTS: We matched 201 SWC subjects to 201 prolonged ICU survivors (402-subject cohort); 42% had a Charlson score of > 4. Risk of death at 12 months was lower in SWC subjects (hazard ratio [HR] 0.70 [95% CI 0.54–0.91]) adjusting for length of hospital admission (HR 1.02 [95% CI 1.00–1.04]) and number of care location transfers (HR 0.84 [95% CI 0.75–0.93]). By follow-up end, more SWC subjects died, 149 (73%) versus 127 (62%). We found no difference in discharge to home. At 12 months, acute health care utilization was comparable for the entire cohort, except hospital readmission rates (median interquartile range [IQR] 2 [1–3) vs 1 [1–2] d). Median (IQR) cost 12 months after unit discharge was CAD $68,165 ($19,894–$153,475). 12-month costs were higher in the SWC survivors (CAD $82,874 [$29,942–$224,965] vs CAD $55,574 [$6,572–$128,962], P < .001). SWC survivors had higher community health care utilization. Regression modeling demonstrated cost was associated with stay and care transfers but not SWC admission. Over 12-y follow-up, health care utilization and costs were higher in SWC survivors.
CONCLUSIONS: SWC admission may confer some medium-term survival advantage; however, this may be influenced by selection bias associated with admission criteria.
Footnotes
- Correspondence: Louise Rose RN MN PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, 57 Waterloo Road, London, UK, SE1 8WA. E-mail: louise.rose{at}kcl.ac.uk
See the Related Editorial on Page 375
Supplemental material related to this paper is available at http://rc.rcjournal.com.
The authors have disclosed no conflicts of interest.
This study was supported by the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care.
This study was performed at the Institute for Clinical Evaluative Sciences and Michael Garron Hospital, Toronto, Canada.
Parts of this material are based on data and information compiled and provided by Canadian Institute for Health Information.
The opinions, results, and conclusions reported in this paper are solely those of the authors and do not represent an endorsement by or the views of the Institute for Clinical Evaluative Sciences, Canadian Institute for Health Information, or Ontario Ministry of Health and Long-Term Care.
- Copyright © 2022 by Daedalus Enterprises
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