Impacto de las altas no programadas en la mortalidad hospitalaria tras la estancia en una unidad de cuidados intensivos

Abstract

ORIGINALImpacto de las altas no programadas en la mortalidad hospitalaria tras la estancia en una unidad de cuidados intensivos ResumenObjetivos: Comprobar la frecuencia de altas no programadas y su relación con la mortalidad hospitalaria tras la estancia en UCI. Diseño: Registro prospectivo de los ingresos de 6 años consecutivos. Análisis retrospectivo de la primera admisión de la cohorte de los supervivientes a UCI. Ámbito: UCI polivalente de 10 camas en hospital general de segundo nivel con 540 camas. Pacientes: 1.521 pacientes con más de 12 horas de estancia, dados de alta vivos y con desenlace hospitalario conocido.Intervenciones: Ninguna. Principales variables de interés: Se registró el tipo de alta de la unidad, normal o no programada, y se exploró su relación con la mortalidad hospitalaria post-UCI, las tasas de readmisión y la estancia hospitalaria post-UCI. Resultados: Hubo 165 altas no programadas (10,8%). La tasa de mortalidad fue del 11,6% (176 pacientes). Los factores relacionados con la mortalidad fueron la limitación del esfuerzo terapéutico (OR = 14,02 [4,6]), las readmisiones (OR = 3,46 [1,78]), las altas no programadas (OR = 2,16 [1,41]), la puntuación de fallos orgánicos al alta de UCI (OR = 1,16 [1,01-1,32]) y la edad (OR = 1,03 [1,01-1,05]). Las readmisiones y las estancias post-UCI no diferían significativamente entre las altas no programadas y las normales (el 7,3 frente al 8,2%; p = 0,68 y 16, 7 ± 16,7 frente a 18,7 ± 21,3 días, respectivamente; p = 0,162). Conclusiones: Las altas no programadas son frecuentes en nuestro medio y contribuyen significativamente a la mortalidad post-UCI, sin que parezcan afectar a otros resultados de la asistencia a pacientes críticos. Impact of the premature discharge on hospital mortality after a stay in an intensive care unit Abstract Objective: To determine the frequency and to evaluate the relationship between premature discharge and post-ICU hospital mortality. Design: A prospective registry was made for patients admitted during six consecutive years, performing a retrospective analysis of the data on the first admission of ICU survivors. Setting: A 10-bed general ICU in a 540-bed tertiary-care community hospital. Patients: 1,521 patients with an ICU stay longer than 12 hours, discharged alive to wards with known hospital outcome. Interventions: None. Main variables:We recorded the patient data, including types of ICU discharge, normal or premature, and studying their relationship with post-ICU hospital mortality. The types of ICU discharge were also evaluated versus ICU readmission rate and post-ICU length of stay. Results: There were 165 patients (10.8%) with premature discharge. Mortality rate was 11.6% (176 patients). The factors related with mortality were withdrawal and limitation of life-sustaining treatments (OR=14. 02 [4.6-42.6 Conclusions: Premature discharges appear to be common in our setting and have a significant impact on mortality. Types of ICU discharge do not seem to be related with other outcome variables in the hospital care of cr...

Association between time of discharge from ICU and hospital mortality: a systematic review and meta-analysis

“…Premature ICU discharge was an independent risk factor for mortality in some studies [5, 39], and an additional 48 h of ICU stay may provide a 39% reduction in mortality among high-risk patients [40, 41]. Two of the included studies included adjustment for premature discharge, and we did not observe a significant relationship between nighttime discharge and hospital mortality in this subgroup [5, 7].…”

Association Between Nighttime Discharge from the Intensive Care Unit and Hospital Mortality: A Multi-Center Retrospective Cohort Study

“…Prior studies provide support for these hypotheses. Premature ICU discharge has been shown to be an independent risk for mortality [ 20 ]. Interestingly, a triage model to predict premature ICU discharge for “at-risk” patients was found to predict a 39 % reduction in mortality if these patients remained in the ICU for further 48 h [ 21 ].…”

Life-sustaining treatment limitation criteria upon admission to the intensive care unit: Results of a Spanish national multicenter survey

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