Admission factors associated with prolonged (&gt;14 days) intensive care unit stay

Chronic obstructive pulmonary disease (COPD) care across Europe has high heterogeneity with respect to cost and the services available. Variations in length of stay (LOS) may be attributed to patient characteristics, resource and organisational characteristics, and/or the so-called hospital cluster effect.The European COPD Audit in 13 countries included data from 16 018 hospitalised patients. The recorded variables included information on patient and disease characteristics, and resources available. Variables associated with LOS were evaluated by a multivariate, multilevel analysis.Mean±sd LOS was 8.7±8.3 days (median 7 days, interquartile range 4–11 days). Crude variability between countries was reduced after accounting for clinical factors and the clustering effect. The main factors associated with LOS being longer than the median were related to disease or exacerbation severity, including GOLD class IV (OR 1.77) and use of mechanical ventilation (OR 2.15). Few individual resource variables were associated with LOS after accounting for the hospital cluster effect.This study emphasises the importance of the patients' clinical severity at presentation in predicting LOS. Identifying patients at risk of a long hospital stay at admission and providing targeted interventions offers the potential to reduce LOS for these individuals. The complex interactions between factors and systems were more important that any single resource or organisational factor in determining differences in LOS between hospitals or countries.

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“…This finding is in keeping with previous reports [8, 35, 36]. A history of previous admissions was also associated with longer LOS.…”

Section: Discussionsupporting

confidence: 93%

Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

et al. 2016

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“…In literature, unexpected admissions of patients from wards or after surgical procedures correlated with LoS in ICU (6,9). In our results, Los was similar in surgical and nonsurgical patients and not found a predictive factor of Los (p=0.27).…”

Section: Discussionsupporting

confidence: 54%

“…It has been variously defined as over 10, 21 or 30 days (3)(4)(5). More recently Zampieri et al (6) described at the least a 14-day stay in ICU as being prolonged. The ratio of the prolonged stay was previously reported on 4-11% of all admission (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

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Prolonged Stay in Intensive Care Unit: Retrospective Analysis of Predisposing Factors and Outcome

Çevik¹,

Geyik²

2019

tybd

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ÖZ Amaç: Yoğun bakım ünitelerinde uzun yatış, maliyetin artması, kaynakların kullanılması, hasta mortalite ve morbiditesi ile sonuçlanan ciddi bir problemdir. Bu çalışmada yoğun bakım ünitesinde yatış süresinin uzamasına etki eden faktörlerin tartışılması amaçlandı. Gereç ve Yöntem: 2015-2017 yılları arasında 14 günden uzun yatan 219 hasta retrospektif olarak incelendi. Yaş, cinsiyet, yatış nedeni, yatış süresi, mekanik ventilasyon süresi, renal replasman tedavisi ihtiyacı, trakeotomi, kan transfüzyonu ihtiyacı, inotropik ve vazopresör ilaçların kullanımı ve tanımlanmış enfeksiyon varlığının yatış süresi üzerine etkileri incelendi. Bulgular: Uzun yatan hasta oranı tüm yatışların %14,56'sı idi. Yaş ortalaması 64,74±18,18 yıldı ve kalış süresinin uzamasında belirleyici bir faktör olarak bulundu (p=0,006). Erkek hastaların oranı %63,47 idi ve tüm hastaların %67,58'si cerrahi dışı nedenlerden dolayı kabul edilmişti. Cinsiyet (p=0,73) ve yatış nedeni (p=0,629) yatış süresini etkileyen faktörler olarak saptanmadı. Yüksek APACHE II skoru (p=0,000), mekanik ventilasyon süresi (p=0,025), renal replasman tedavisi (p=0,000), trakeotomi (p=0,25), inotropik ve vazopresör ihtiyacı (p=0,015) yoğun bakım ünitesinde uzun yatış süresini etkileyen diğer faktörler olarak belirlendi. Mortalite tüm uzun yatışlarda %67,13, yatış süresi 30 günden fazla olan hastalarda %85,04 idi. Yatış süresi uzamış hastalarda mortalite anlamlı olarak yüksek bulundu (p=0,004). Sonuç: Birçok nedenden dolayı yoğun bakım hastalarının yatış süreleri uzamakta ve bu durum yoğun bakım kaynaklarının verimli kullanılamamasının önemli nedenlerinden biri olarak karşımıza çıkmaktadır. Palyatif ve ara bakım ünitelerinin geliştirilmesi ve evde bakım hizmetlerinin yaygınlaştırılmasının yoğun bakım yatak uygunluk oranlarının arttırılmasında büyük rol oynayacağı kanısındayız. Anahtar Kelimeler: Yoğun bakım ünitesi, yatış süresi, risk faktörleri ABSTRACT Objective: Prolonged stay in the intensive care unit (ICU) is a serious problem resulting in increased cost, resource utilization, and morbidity and mortality. This study was aimed to discuss the factors affecting the prolonged stay in ICU. Materials and Methods: The data of 219 patients between the years 2015-2019 were evaluated retrospectively. The factors affecting the prolonged stay in ICU were evaluated, including age, gender, reason of admission, length of stay, duration of mechanical ventilation, identified infection, and requirement for renal replacement therapy, tracheotomy, blood transfusion, inotropic and vasopressor agents. Results: The rate of prolonged stay in ICU was 14.56% for all admissions. The mean age of the patients was 64.74±18.18 years and the age was a predictive factor for the prolonged stay (p=0.006). The percentage of the male patient was %63.47 and 67.58% of all patients were admitted due to non-surgical reasons. Gender (p=0.73) and the reason for admission (p=0.629) were not predictive factors for prolonged stay. High APACHE II score (p=0.000), duration of mechanical ventilation (p=0.025), re...

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“…Patients who were transferred to other hospitals were also excluded, as were patients whose PS data were absent from the database (Figure 1 – study flowchart). A simplified PS is routinely assessed at ICU admission, as previously described [16]. Briefly, a PS of 0 is used to define patients who are independent in terms of all basic daily activities.…”

Section: Methodsmentioning

confidence: 99%

The impact of performance status and comorbidities on the short-term prognosis of very elderly patients admitted to the ICU

Zampieri

Colombari

2014

BMC Anesthesiol

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BackgroundPatients ≥80 years of age are increasingly being admitted to the intensive care unit (ICU). The impact of relevant variables, such comorbidities and performance status, on short-term outcomes in the very elderly is largely unknown. Few studies address the calibration of illness severity scores (SAPS3 score) within this population. We investigated the risk factors for hospital mortality in critically ill patients ≥80 years old, emphasizing performance status and comorbidities, and assessed the calibration of SAPS3 scores in this population.Methods1129 very elderly patients admitted to a tertiary ICU in Brazil during a two-year period were retrospectively included in this study. Demographic features, reasons for admission, illness severity, comorbidities (including the Charlson Comorbidity Index) and a simplified performance status measurement were obtained. After univariate analysis, a multivariate model was created to evaluate the factors that were associated with hospital mortality. Alternatively, a conditional inference tree with recursive partitioning was constructed. Calibration of the SAPS3 scores and the multivariate model were evaluated using the Hosmer-Lemeshow test and a calibration plot. Discrimination was assessed using a receiver operating characteristics curve.ResultsOn multivariate analysis after stepwise regression, only the SAPS3 score (OR 1.08, 95% CI 1.06-1.10), Charlson Index (OR 1.16, 95% CI 1.07-1.27), performance status (OR 1.61, 95% CI 1.05-2.64 for partially dependent patients and OR 2.39, 95% CI 1.38-4.13 for fully dependent patients) and a non-full code status (OR 11.74, 95% CI 6.22-22.160) were associated with increased hospital mortality. Conditional inference tree showed that performance status and Charlson Index had the greatest influence on patients with less severe disease, whereas a non-full code status was prominent in patients with higher illness severity (SAPS3 score >61). The model obtained after logistic regression that included the before mentioned variables demonstrated better calibration and greater discrimination capability (AUC 0.86, 95% CI 0.83-0.89 versus AUC 0.81, 95% CI 0.78-0.84, respectively; p < 0.001) than the SAPS3 score alone.ConclusionsPerformance status and comorbidities are important determinants of short-term outcome in critically ill elderly patients ≥80 years old. The addition of simple background information may increase the calibration of the SAPS3 score in this population.

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Admission factors associated with prolonged (>14 days) intensive care unit stay

Cited by 29 publications

References 28 publications

Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

Prolonged Stay in Intensive Care Unit: Retrospective Analysis of Predisposing Factors and Outcome

The impact of performance status and comorbidities on the short-term prognosis of very elderly patients admitted to the ICU

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