The outcomes and prognostic factors of the patients with unplanned intensive care unit readmissions

Lin, Wei−Ting; Chen, Wan-Ling; Chao, Chien‐Ming; Lai, Chih‐Cheng

doi:10.1097/md.0000000000011124

Cited by 21 publications

(32 citation statements)

References 22 publications

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“…Particularly, hypertension has been prevalent among individuals with a mean age 44, whereas the mean age for diabetes is 49 years old [ 28 ]. Similar to other studies, we observed higher mortality among male patients (62.1%) [ 22 – 24 ], inpatients transferred to the ICU (18.2%), and diagnosed with sepsis (41.9%). Those findings are 2.5 times higher than those observed in multicentric studies conducted in 65 ICU from all Brazilian territory where mortality rates by sepsis alone were 16.7% [ 29 ].…”

Section: Discussionsupporting

confidence: 90%

“…is study identified a 21% ICU mortality rate among patients in the hospital of Sergipe, northeastern Brazil. e mortality rate is considered high when compared to other national and international studies [1,2,[23][24][25]. Age, admission from inpatient unit, sepsis, hydroelectrolyte imbalance, changes in glycemic index, tube feeding, mechanic ventilation, sedation with fentanyl, insulin use, and higher Charlson scores were associated with mortality in this study.…”

Section: Discussionmentioning

confidence: 55%

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Mortality Predictors and Associated Factors in Patients in the Intensive Care Unit: A Cross-Sectional Study

Pinheiro

Santana–Santos

Barreto

et al. 2020

Critical Care Research and Practice

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Background. Mortality in the intensive care unit (ICU) has been associated to an array of risk factors. Identification of risk factors potentially contribute to predict and reduce mortality rates in the ICU. The objectives of the study were to determine the prevalence and the factors associated with the mortality and to analyze the survival. Method. A cross-sectional study conducted in two clinical and surgical ICU in the state of Sergipe, northeastern Brazil. We enrolled 316 patients with at least 48 h of hospitalization, minimum age of 18 years old, sedated or weaned, with RASS ≥ −3, between July 2017 and April 2018. We categorized data in (1) age and gender, (2) clinical condition, and (3) prevalence of delirium. Data from enrolled patients were collected from enrollment until death or ICU discharge. Patients’ outcomes were categorized in (1) death and (2) nondeath (discharge). Results. Twenty-one percent of participants died. Age (53 ± 17 years vs. 45 ± 18 years, p<0.01), electrolyte disturbance (30.3% vs 18.1%, p=0.029), glycemic index (33.3% vs 18.2%, p=0.008), tube feeding (83.3% vs 67.1%, p=0.01), mechanical ventilation (50% vs 35.7%, p=0.035), sedation with fentanyl (24.2 vs 13.6, p=0.035), use of insulin (33.8% vs 21.7%, p=0.042), and higher Charlson score (2.61 vs 2.17, p=0.041) were significantly associated with death on the adjusted model. However, the regression model indicated that patients admitted from the emergency (HR = 0.40, p=0.006) and glycemic index alterations (HR = 1.68, p=0.047) were associated with mortality. There was no statistically significant difference (p=0.540) in survival between patients with and without delirium, based on the survival analysis and length of hospitalization. Conclusion. The prevalence of death was 21%, and age, electrolyte disturbance, glycemic index, tube feeding, mechanical ventilation, sedation with fentanyl, use of insulin, and higher Charlson score were associated with mortality.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 55%

Mortality Predictors and Associated Factors in Patients in the Intensive Care Unit: A Cross-Sectional Study

Pinheiro

Santana–Santos

Barreto

et al. 2020

Critical Care Research and Practice

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“…In conclusion, the patients who are discharged from ICU are at a high risk of being readmitted to ICU (34). Readmission to ICU is associated with higher mortality risk than the initial admission (35). Considering the funding for ICU services which consumes substantial amount of health resources, a decrease in the readmission to ICU rates can be used as a hospital performance indicator (36)(37)(38).…”

Section: Resultsmentioning

confidence: 99%

Evaluation of Readmitted Patients After Intensive Care Unit Discharge (Retrospective Study)

Çayören¹,

Müslümanoğlu²,

Sevdi³

et al. 2019

BMB

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Nearly %10 of the discharged patients are readmitted to intensive care unit (ICU) at the same hospital stay. Reduction of readmission rates could be used as a hospital performance indicator. Our aim is to analyse the reasons and results of readmissions of patients who were discharged to a general ward from ICU in a two-year period. Method: Readmissions of the patients who had been treated in our ICU between the dates of 01.01.2015-31.12.2016 were analysed retrospectively. Demographic characteristics of patients, readmission rates, initial admission indications and comorbidities, distribution of readmission indications, timing of readmission after discharge, distribution of patients in terms of mechanical ventilation need, discharge time of readmitted patients at initial admission to ICU after weaning, readmission mortality rates, Glasgow Coma Scale (GCS), APACHE-II and SOFA scores of patients at initial admission and readmission were analysed and compared. Results: 59 patients (3.55%) are readmitted to ICU after discharge at the same hospital stay. When examining the departments where the readmitted patients came from, it is seen that 19 patients (32.2%) were readmitted to ICU from department of general surgery. 22 of readmissions (37.29%) occurred within first 48 hours after discharge. The most common reasons of readmissions are for postoperative monitoring after revisional surgery (44.07%) and acute respiratory failure (40.68%). Conclusion: The patients who are discharged from ICU are at a high risk of being readmitted to ICU (35). Readmission to ICU is associated with higher mortality risk than the initial admission. The first step of reducing Amaç: Taburcu edilen hastaların yaklaşık %10' u yatış süresi içerisinde yeniden yoğun bakım ünitesine (YBÜ) gitmektedir. YBÜ'ye yeniden yatış oranlarındaki azalma, hastane performansında bir kalite göstergesidir. Bu çalışmadaki amacımız, YBÜ'den hastane içine, iki yıllık süre içerisinde taburcu edilen hastaların yeniden yatışlarının nedenlerini ve sonuçlarını analiz etmektir. Yöntem: 01.01.2015-31.12.2016 tarihleri arasında hastanemiz YBÜ'de tedavi edilen hastaların tekrar yatışları geriye dönük olarak incelendi. Hastaların demografik özellikleri, tekrar yatış oranları, hastaların ilk yatış endikasyonları ve yandaş hastalıkları, tekrar yatışların endikasyonlarına göre dağılımı, tekrar yatışın taburculuk sonrası ne zaman gerçekleştiği, mekanik ventilasyon ihtiyacına göre hastaların dağılımı, tekrar yatışı olan hastaların birinci kabullerinde weaning sonrası taburcu olma zamanı, tekrar yatışlardaki mortalite oranları, hastaların YBÜ'ye ilk ve tekrar yatışındaki Glasgow Koma Skalası (GCS), APACHE-II ve SOFA skorları incelenerek kıyaslandı. Bulgular: YBÜ'den taburcu edilen ve hastaneden taburcu olmadan tekrar yatışı yapılan hasta sayısı 59 olarak bulundu (%3,55). Hastaların tekrar geldikleri bölümler incelendiğinde en fazla 19 (%32,2) hasta Genel Cerrahi Kliniği'ndendi. Tekrar kabul edilen hastaların 22'si (%37,29) taburcu edildikten sonraki ilk 48 saat içinde gerçekleşti. T...

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“…Organ dysfunction can be identified as an acute change in the total SOFA score of 2 points consequent to infection (13). Respiratory failure was the most common cause of intensive care unit (ICU) admission, followed by acute myocardial ischemia or worsening heart failure, sepsis, gastrointestinal disease, and neurological disease (14). Patients who underwent emergency surgery for peritonitis due to colorectal perforation, did not develop respiratory disorders and required short-term mechanical ventilation after surgery, did not develop sepsis.…”

Section: Discussionmentioning

confidence: 99%

Respiratory Disorder at the End of Surgery for Peritonitis Due to Colorectal Perforation Is a Critical Predictor of Postoperative Sepsis

Mouri

Kawahara

Matsumoto

et al. 2019

In Vivo

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Background/Aim: The aim of this study was to identify a critical predictor of postoperative sepsis in patients with peritonitis due to colorectal perforation. Patients and Methods: Between 2009 and 2014, fifty-three patients who underwent emergency surgery for peritonitis due to colorectal perforation in our hospital were examined retrospectively to identify the critical predictor of postoperative sepsis. Between 2016 and 2017, twelve patients with peritonitis due to colorectal perforation were enrolled in a prospective study to validate the critical predictor obtained by the previous retrospective study. Results: Mechanical ventilation for more than two days after surgery seemed to be a critical predictor of postoperative sepsis. In the prospective study, six patients who were withdrawn from mechanical ventilation within one day after surgery did not develop sepsis. Conclusion: Respiratory disorders at the end of surgery for peritonitis due to colorectal perforation seem to be a critical predictor of postoperative sepsis. Emergency surgery is usually required for peritonitis due to colorectal perforation. The morbidity and mortality rates are high due to the performance of emergency surgery itself, incomplete bowel preparation, bacterial proliferation, and contamination (1, 2). Several factors, including the age of the patient, preoperative condition, complications, and disease type, have been reported to affect the mortality and the morbidity rates (3, 4). Severe postoperative infection often results in serious life-threatening complications, such as sepsis, septic disseminated intravascular coagulation and septic shock (5-7). However, a critical predictor of postoperative sepsis remains unclear. The aim of this study was to identify a critical predictor of postoperative sepsis for patients with peritonitis due to colorectal perforation.

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The outcomes and prognostic factors of the patients with unplanned intensive care unit readmissions

Cited by 21 publications

References 22 publications

Mortality Predictors and Associated Factors in Patients in the Intensive Care Unit: A Cross-Sectional Study

Mortality Predictors and Associated Factors in Patients in the Intensive Care Unit: A Cross-Sectional Study

Evaluation of Readmitted Patients After Intensive Care Unit Discharge (Retrospective Study)

Respiratory Disorder at the End of Surgery for Peritonitis Due to Colorectal Perforation Is a Critical Predictor of Postoperative Sepsis

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