Log in | Register

Increased risk of death and readmission after hospital discharge of critically ill patients in a developing country: a retrospective multicenter cohort study

Vanessa Chaves Barreto Ferreira de Lima| Ana Luiza Bierrenbach| Gizelton Pereira Alencar| Ana Lucia Andrade| Luciano Cesar Pontes Azevedo
Original
Volume 44, Issue 7 / July , 2018

Pages 1090 - 1096

Abstract

Purpose

To describe long-term mortality and hospital readmissions of patients admitted to Brazilian intensive care units (ICU).

Methods

Retrospective cohort study of adult patients admitted to Brazilian hospitals affiliated to the Public Healthcare System from 10 state capitals. ICU patients were paired to non-ICU patients by frequency matching (ratio 1:2), according to postal code and admission semester. Hospitalization records were linked through deterministic linkage to national mortality data. Primary outcome was mortality up to 1 year. Other outcomes were mortality and readmissions at 30 and 90 days and 3 years. Multiple Cox regressions were used adjusting for age, sex, cancer diagnosis, type of hospital, and surgical status.

Results

We included 324,594 patients (108,302 ICU and 216,292 non-ICU). ICU patients had increased hospital length of stay [9 (5–17) vs. 3 (1–6) days, p < 0.001] and mortality (18.5 vs. 3.6%, p < 0.001) versus non-ICU patients. One year after discharge, ICU patients were more frequently readmitted to hospital (25.4 vs. 17.4%, p < 0.001) and to ICU (31.4 vs. 7.3%, p < 0.001) than controls. Mortality up to 1 year was also higher for ICU patients (14.3 vs. 3.9%, p < 0.001). A significant interaction between surgical status and mortality was found, with adjusted hazard ratios (HRs) up to 1 year of 2.7 [95% confidence interval (CI) 2.5–2.9] for surgical patients, and 3.4 (95%CI 3.3–3.5) for medical patients. The risk for death and readmission diminished over time up to 3 years.

Conclusions

In a public healthcare system of a developing country, ICU patients have excessive long-term mortality and frequent readmissions. The ICU burden tended to reduce over time after hospital discharge.

Keywords

References

  1. Angus DC, Carlet J, Brussels Roundtable P (2003) Surviving intensive care: a report from the 2002 Brussels Roundtable. Intensive Care Med 29:368–377
  2. Wunsch H, Guerra C, Barnato AE, Angus DC, Li G, Linde-Zwirble WT (2010) Three-year outcomes for Medicare beneficiaries who survive intensive care. JAMA 303:849–856
    • View reference on publisher's website
    • View reference on PubMed
  3. Wright JC, Plenderleith L, Ridley SA (2003) Long-term survival following intensive care: subgroup analysis and comparison with the general population. Anaesthesia 58:637–642
    • View reference on publisher's website
    • View reference on PubMed
  4. Hill AD, Fowler RA, Pinto R, Herridge MS, Cuthbertson BH, Scales DC (2016) Long-term outcomes and healthcare utilization following critical illness–a population-based study. Crit Care 20:76
    • View reference on publisher's website
    • View reference on PubMed
  5. Niskanen M, Kari A, Halonen P (1996) Five-year survival after intensive care–comparison of 12,180 patients with the general population. Finnish ICU Study Group. Crit Care Med 24:1962–1967
    • View reference on publisher's website
    • View reference on PubMed
  6. Garland A, Olafson K, Ramsey CD, Yogendran M, Fransoo R (2015) A population-based observational study of intensive care unit-related outcomes. With emphasis on post-hospital outcomes. Ann Am Thorac Soc 12:202–208
    • View reference on publisher's website
    • View reference on PubMed
  7. Ranzani OT, Zampieri FG, Besen BA, Azevedo LC, Park M (2015) One-year survival and resource use after critical illness: impact of organ failure and residual organ dysfunction in a cohort study in Brazil. Crit Care 19:269
    • View reference on publisher's website
    • View reference on PubMed
  8. Lone NI, Gillies MA, Haddow C, Dobbie R, Rowan KM, Wild SH, Murray GD, Walsh TS (2016) Five-year mortality and hospital costs associated with surviving intensive care. Am J Respir Crit Care Med 194:198–208
    • View reference on publisher's website
    • View reference on PubMed
  9. Haas B, Wunsch H (2016) How does prior health status (age, comorbidities and frailty) determine critical illness and outcome? Curr Opin Crit Care 22:500–505
    • View reference on publisher's website
    • View reference on PubMed
  10. Haas JS, Teixeira C, Cabral CR, Fleig AH, Freitas AP, Treptow EC, Rizzotto MI, Machado AS, Balzano PC, Hetzel MP, Dallegrave DM, Oliveira RP, Savi A, Vieira SR (2013) Factors influencing physical functional status in intensive care unit survivors two years after discharge. BMC Anesthesiol 13:11
    • View reference on publisher's website
    • View reference on PubMed
  11. Wunsch H, Angus DC, Harrison DA, Linde-Zwirble WT, Rowan KM (2011) Comparison of medical admissions to intensive care units in the United States and United Kingdom. Am J Respir Crit Care Med 183:1666–1673
    • View reference on publisher's website
    • View reference on PubMed
  12. Soares M, Bozza FA, Angus DC, Japiassu AM, Viana WN, Costa R, Brauer L, Mazza BF, Correa TD, Nunes AL, Lisboa T, Colombari F, Maciel AT, Azevedo LC, Damasceno M, Fernandes HS, Cavalcanti AB, do Brasil PE, Kahn JM, Salluh JI (2015) Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study. Intensive Care Med 41:2149–2160
  13. Luangasanatip N, Hongsuwan M, Lubell Y, Limmathurotsakul D, Teparrukkul P, Chaowarat S, Day NP, Graves N, Cooper BS (2013) Long-term survival after intensive care unit discharge in Thailand: a retrospective study. Crit Care 17:R219
    • View reference on publisher's website
    • View reference on PubMed
  14. Fildissis G, Zidianakis V, Tsigou E, Koulenti D, Katostaras T, Economou A, Baltopoulos G (2007) Quality of life outcome of critical care survivors eighteen months after discharge from intensive care. Croat Med J 48:814–821
    • View reference on publisher's website
    • View reference on PubMed
  15. Miranda AF, Miranda S (1991) Quality of life and longterm survival after intensive care discharge. Med J Malaysia 46:66–71
    • View reference on PubMed
  16. Normilio-Silva K, de Figueiredo AC, Pedroso-de-Lima AC, Tunes-da-Silva G, da Silva AN, Levites ADD, de-Simone AT, Safra PL, Zancani R, Tonini PC, de Andrade ESUV, Silva TB, Giorgi JM, Eluf-Neto J, Costa A, Hajjar LA, Cavalcanti AB (2016) Long-term survival, quality of life, and quality-adjusted survival in critically ill patients with cancer. Crit Care Med 44:1327–1337
    • View reference on publisher's website
    • View reference on PubMed
  17. Bittencourt SA, Camacho LA, Leal Mdo C (2006) Hospital information systems and their application in public health. Cad Saude Publica 22:19–30
    • View reference on publisher's website
    • View reference on PubMed
  18. Jorge MH, Laurenti R, Di Nubila HB (2010) Death and its epidemiological investigation: considerations about some relevant aspects. Rev Bras Epidemiol 13:561–576
    • View reference on publisher's website
    • View reference on PubMed
  19. Taniguchi LU, Bierrenbach AL, Toscano CM, Schettino GP, Azevedo LC (2014) Sepsis-related deaths in Brazil: an analysis of the national mortality registry from 2002 to 2010. Crit Care 18:608
    • View reference on publisher's website
    • View reference on PubMed
  20. Pacheco AG, Saraceni V, Tuboi SH, Moulton LH, Chaisson RE, Cavalcante SC, Durovni B, Faulhaber JC, Golub JE, King B, Schechter M, Harrison LH (2008) Validation of a hierarchical deterministic record-linkage algorithm using data from 2 different cohorts of human immunodeficiency virus-infected persons and mortality databases in Brazil. Am J Epidemiol 168:1326–1332
    • View reference on publisher's website
    • View reference on PubMed
  21. Azevedo LC, Toscano CM, Bierrenbach AL (2013) Bacterial Meningitis in Brazil: baseline epidemiologic assessment of the decade prior to the introduction of pneumococcal and meningococcal vaccines. PLoS One 8:e64524
    • View reference on publisher's website
    • View reference on PubMed
  22. Oliveira GP, Bierrenbach AL, Camargo KRJ, Coeli CM, Pinheiro RS (2016) Accuracy of probabilistic and deterministic record linkage: the case of tuberculosis. Rev Saude Publica 50:49
    • View reference on PubMed
  23. Guiltinan AM, Kaidarova Z, Custer B, Orland J, Strollo A, Cyrus S, Busch MP, Murphy EL (2008) Increased all-cause, liver, and cardiac mortality among hepatitis C virus-seropositive blood donors. Am J Epidemiol 167:743–750
    • View reference on publisher's website
    • View reference on PubMed
  24. Fiscella K, Franks P (2001) Impact of patient socioeconomic status on physician profiles: a comparison of census-derived and individual measures. Med Care 39:8–14
    • View reference on publisher's website
    • View reference on PubMed
  25. Venables WN, Ripley BD (2002) Modern Applied Statistics With S. Springer, New York
  26. Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, Zawistowski C, Bemis-Dougherty A, Berney SC, Bienvenu OJ, Brady SL, Brodsky MB, Denehy L, Elliott D, Flatley C, Harabin AL, Jones C, Louis D, Meltzer W, Muldoon SR, Palmer JB, Perme C, Robinson M, Schmidt DM, Scruth E, Spill GR, Storey CP, Render M, Votto J, Harvey MA (2012) Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med 40:502–509
    • View reference on publisher's website
    • View reference on PubMed
  27. Garland A, Olafson K, Ramsey CD, Yogendran M, Fransoo R (2014) Distinct determinants of long-term and short-term survival in critical illness. Intensive Care Med 40:1097–1105
  28. Prescott HC, Osterholzer JJ, Langa KM, Angus DC, Iwashyna TJ (2016) Late mortality after sepsis: propensity matched cohort study. BMJ 353:i2375
    • View reference on publisher's website
    • View reference on PubMed

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement