Relationship Between ICU Length of Stay and Long-Term Mortality for Elderly ICU Survivors*

Abstract

Objective To evaluate the association between length of ICU stay and 1-year mortality for elderly patients who survived to hospital discharge in the United States. Design and Setting Retrospective cohort study of a random sample of Medicare beneficiaries who survived to hospital discharge, with 1 and 3-year follow-up, stratified by the number of days of intensive care and with additional stratification based on receipt of mechanical ventilation. Interventions None Patients The cohort included 34,696 Medicare beneficiaries older than 65 years who received intensive care and survived to hospital discharge in 2005. Measurements and Main Results Among 34,696 patients who survived to hospital discharge, the mean ICU length of stay was 3.4 (±4.5) days. 88.9% of patients were in the ICU for 1–6 days, representing 58.6% of ICU bed-days. 1.3% of patients were in the ICU for 21+ days, but these patients used 11.6% of bed-days. The percentage of mechanically ventilated patients increased with increasing length of stay (6.3% for 1–6 days in the ICU and 71.3% for 21+ days). One-year mortality was 26.6%, ranging from 19.4% for patients in the ICU for one day, up to 57.8% for patients in the ICU for 21+ days. For each day beyond seven days in the ICU, there was an increased odds of death by 1-year of 1.04 (95% CI 1.03–1.05) irrespective of the need for mechanical ventilation. Conclusions Increasing ICU length of stay is associated with higher 1-year mortality for both mechanically ventilated and non-mechanically ventilated patients. No specific cut-off was associated with a clear plateau or sharp increase in long-term risk.

“Never in my mind to give up!” A qualitative study of long‐term intensive care patients’ inner strength and willpower—Promoting and challenging aspects

“…ICU patients staying a shorter period in the ICU encountered different challenges compared to the long‐term ICU patients (Moitra et al, ). Hence, the present findings might have less significance to the care of patients having shorter stays at the ICU.…”

“…However, evidence displays that long‐term ICU patients suffer from a variety of afflictions and struggles during and past their ICU stay, including postintensive care syndrome (PICS). PICS is characterised by mental, cognitive or physical impairments and may lead to disabilities (Hodgson et al, ; Mehlhorn et al, ; Moitra et al, ). Former ICU patients experience different degrees of disabilities.…”

“…Internationally, long-term intensive care patients are defined by a stay of 7 days or more, representing about 10% of all intensive care patients (Carden, Graham, McLennan, & Celi, 2008;Moitra, Guerra, Linde-Zwirble, & Wunsch, 2016). In Norway, approximately 15,000 patients are treated annually in intensive care units (ICUs).…”

“…The medical conditions of long-term ICU patients often fluctuate due to complications such as infections and re-intubation. ICU stays beyond 7 days are associated with a high mortality rate (Carden et al, 2008;Moitra et al, 2016) and elevated rates of psychopathology (Kean et al, 2017;McGiffin, Galatzer-Levy, & Bonanno, 2016). In spite of multiple challenges from long-term, life-threatening illnesses, along with medical treatment and nursing interventions, some long-term ICU patients demonstrate an exceptional inner strength (Smith, Dingley, & Roux, 2018) and will to go on living (Alpers, Helseth, & Bergbom, 2012;Engstrøm, Nystrøm, Sundelin, & Rattray, 2013).…”

The course and outcome of patients older than 79 years treated in intensive care unit

“…Należy jednak pamiętać, że śmiertelność szpitalna także była zbliżo-na w obu grupach. Stanowi to dowód na to, że czas hospitalizacji na oddziale intensywnej terapii ma najistotniejszy związek ze śmiertelnością, co udowodniono już wcześniej w sposób jednoznaczny na ogromnej populacji prawie 35 000 chorych powyżej 65 roku życia przyjmowanych w Stanach Zjednoczonych na tamtejsze oddziały intensywnej terapii [11]. Przeprowadzona analiza pozwoliła też na uzyskanie informacji dotyczących oddziałów i miejsc, do któ-rych zostali przekazani chorzy po zakończeniu leczenia na OAiIT.…”