Purpose: Existing intensive care unit (ICU) mortality measurement systems address in-hospital mortality only. However, early postdischarge mortality contributes significantly to overall 30-day mortality. Factors associated with early postdischarge mortality are unknown. Methods: We performed a retrospective study of 8484 ICU patients. Our primary outcome was early postdischarge mortality: death after hospital discharge and 30 days or less from ICU admission. Cox regression models assessed the association between patient, hospital, and utilization factors and the primary outcome. Results: In multivariate analyses, the hazard for early postdischarge mortality increased with rising severity of illness and decreased with full-code status (hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.21-0.49). Compared with discharges home, early postdischarge mortality was highest for acute care transfers (HR, 3.18; 95% CI, 2.45-4.12). Finally, patients with very short ICU length of stay (<1 day) had greater early postdischarge mortality (HR, 1.86; 95% CI; 1.32-2.61) than those with longest stays (≥7 days). Conclusions: Early postdischarge mortality is associated with patient preferences (full-code status) and decisions regarding timing and location of discharge. These findings have important implications for anyone attempting to measure or improve ICU performance and who rely on in-hospital mortality measures to do so.
Bibliographical noteFunding Information:
We acknowledge Teresa Chipps, BS, and Christine Bass, MPH, Department of Medicine (General Internal Medicine and Public Health), Center for Health Services Research, Vanderbilt University, Nashville, TN, for their administrative and editorial assistance in the preparation of this manuscript. This work was supported by the California Office of Statewide Health Planning and Development, the Agency for Healthcare Research and Quality ( R01 HS13919‑01 ). Dr Dudley's work was also supported by an Investigator Award in Health Policy from the Robert Wood Johnson Foundation . Dr Vasilevskis was supported by a Ruth L. Kirschstein National Research Service Award institutional research training grant T32 , the Veterans Affairs Clinical Research Center of Excellence, and the Geriatric Research Education and Clinical Center, Veterans Affairs, Tennessee Valley Healthcare, Nashville, Tenn .
- Health services research
- Hospital mortality
- Intensive care unit
- Outcome assessment (Health care)
- Patient discharge
- Transitions of Care