Patients’ Characteristics Associated With Readmission to a Surgical Intensive Care Unit

Abstract

Background Readmission within 48 hours is a leading performance indicator of the quality of care in an intensive care unit. Objective To investigate variables that might be associated with readmission to a surgical intensive care unit. Methods Demographic characteristics, severity-of-illness scores, and survival rates were collected for all patients admitted to a surgical intensive care unit between 1995 and 2000. Long-term survival and quality of life were determined for patients who were readmitted within 30 days after discharge from the unit. Quality of life was measured with the EuroQol-6D questionnaire. Multivariate logistic analysis was used to calculate the independent association of expected covariates. Results Mean follow-up time was 8 years. Of the 1682 patients alive at discharge, 141 (8%) were readmitted. The main causes of readmission were respiratory decompensation (48%) and cardiac conditions (16%). Compared with the total sample, patients readmitted were older, mostly had vascular (39%) or gastrointestinal (26%) disease, and had significantly higher initial severity of illness (P = .003, .007) and significantly more comorbid conditions (P = .005). For all surgical classifications except general surgery, readmission was independently associated with type of admission and need for mechanical ventilation. Long-term mortality was higher among patients who were readmitted than among the total sample. Nevertheless, quality-of-life scores were the same for patients who were readmitted and patients who were not. Conclusion The adverse effect of readmission to the intensive care unit on survival appears to be long-lasting, and predictors of readmission are scarce.

Inflammatory and perfusion markers as risk factors and predictors of critically ill patient readmission

“…Previous studies have indicated that patients with critical health conditions and cumulative organ dysfunctions exhibit an increased risk of readmission. (1,3,4,8-10,32,33) Nonetheless, in the present study, this increased risk was not confirmed by a high SOFA score at ICU discharge.…”

Readmissions to General ICUs in a Geographic Area of Poland Are Seemingly Associated with Better Outcomes

“…Readmitted patients in our study had a lower mean admission APACHE II score (21.2 ± 8.0 vs. 23.2 ± 8.8) and a lower mean TISS-28 score in the first 24 h of their ICU stay (33.7 ± 7.4 vs. 35.2 ±7.8) in comparison to the first-admission patients. Opposite results can be found in the literature, with APACHE II scores found to be higher among readmitted patients in at least two previous studies [27,28]. Our findings were therefore unexpected, and again may stem from the fact that patients discharged from the initial ICU stay constituted only 55%-60% of the initially admitted patients.…”

Unplanned ICU Admission Is Associated With Worse Clinical Outcomes in Geriatric Trauma Patients

“…Of the 2923 patients, 95 (3.3%) experienced UIA during their hospital course including 66 bounce backs (69.5%) and 29 unplanned upgrades (30.5%). On average, patients requiring UIA were older (81 [72-88] versus 78 [70-86], P ¼ 0.04) and more severely injured as measured by ISS (10 [5-17] versus 9 [4][5][6][7][8][9][10][11][12][13] , P < 0.01). Of note, only 26.3% of patients who required UIA had an ISS >15.…”

“…11 Although prior studies have assessed risk factors for ICU readmission in various settings, none have focused specifically on geriatric trauma patients. 4,9,10,12,13 Furthermore, few studies have included patients who required unplanned upgrade to the ICU after initial admission to the floor. Identifying and addressing risk factors for UIA in geriatric trauma patients is critical for improving patient outcomes.…”