Five-Year Mortality and Hospital Costs Associated with Surviving Intensive Care

Abstract

Rationale: Survivors of critical illness experience significant morbidity, but the impact of surviving the intensive care unit (ICU) has not been quantified comprehensively at a population level.Objectives: To identify factors associated with increased hospital resource use and to ascertain whether 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. The population consisted of patients admitted to all adult general ICUs during 2005 and surviving to hospital discharge, identified from the Scottish Intensive Care Society Audit Group registry, matched (1:1) with similar hospital control subjects. Five-year outcomes included mortality and hospital resource use. Confounder adjustment was based on multivariable regression and pre/post within-individual analyses.Measurements and Main Results: Of 7,656 ICU patients, 5,259 survived to hospital discharge (5,215 [99.2%] matched to hospital control subjects). Factors present before ICU admission (comorbidities/pre-ICU hospitalizations) were stronger predictors of hospital resource use than acute illness factors. In the 5 years after the initial hospital discharge, compared with hospital control subjects, the ICU cohort had higher mortality (32.3% vs. 22.7%; hazard ratio, 1.33; 95% confidence interval, 1.22-1.46; P , 0.001), used more hospital resources (mean hospital admission rate, 4.8 vs. 3.3/person/5 yr), and had 51% higher mean 5-year hospital costs ($25,608 vs. $16,913/patient). Increased resource use persisted after confounder adjustment (P , 0.001) and using pre/post-analyses (P , 0.001). Excess resource use and mortality were greatest for younger patients without significant comorbidity.Conclusions: This complete, national study demonstrates that ICU survivorship is associated with higher 5-year mortality and hospital resource use than hospital control subjects, representing a substantial burden on individuals, caregivers, and society.

Outcomes of ICU Patients With a Discharge Diagnosis of Critical Illness Polyneuromyopathy: A Propensity-Matched Analysis

“…However, we could match patients on important markers of illness severity including mechanical ventilation, vasopressor use and organ failure. Although both illness severity and pre-morbid patient characteristics are important for patient outcomes (26, 27), recent data indicate that admission diagnosis and illness severity score become less important for patient outcomes than pre-morbid patient characteristics after a prolonged ICU stay, which is a major reason we included ICU LOS in the propensity match model (28). Most patients in the matched CIPNM and non-CIPNM groups had an ICU LOS longer than 10 days, which is the transition point at which admission diagnosis and illness severity no longer predict outcome better than pre-ICU baseline patient characteristics (which were included in our model).…”

Unplanned early hospital readmission among critical care survivors: a mixed methods study of patients and carers

“…These were a measure of multimorbidity (completed by patients), the Functional Comorbidity Index (FCI),21 to quantify the burden of comorbidity for each patient, and a measure of caregiver strain (completed by caregivers), the Modified Caregiver Strain Index (MCSI) 22. These were included because comorbidity burden is associated with readmissions,14 and caregiver strain and psychological morbidity have been highlighted as prevalent among ICU survivors’ carers 7…”

“…We recently reported that 25% of ICU survivors in Scotland experienced unplanned rehospitalisation within 90 days of hospital discharge,14 a rate comparable with conditions such as heart failure, chronic respiratory disease and pneumonia 15 16. Early rehospitalisation is a widely used healthcare quality indicator that is linked to financial penalisation in some healthcare systems 17.…”

Intensive care: balancing risk and benefit to facilitate informed decisions

“…Limited bed capacity in ICUs results in cancelled urgent operations and in non-clinical transfers to other such units 4. Given that intensive care is an expensive resource with healthcare costs for survivors that commonly extend well beyond admission,5 this trend is unlikely to be sustainable. Crucially, for patients with chronic disease and established frailty, undergoing the burden of a prolonged stay in intensive care for an acute illness may not deliver sustainable benefit,56 with the important caveat that the definition of “benefit” is a very individual thing.…”