Predictors of early postdischarge mortality in critically ill patients: A retrospective cohort study from the California Intensive Care Outcomes project

Eduard E. Vasilevskis; Michael W. Kuzniewicz; Brian A. Cason; Rondall K. Lane; Mitzi L. Dean; Ted Clay; Deborah J. Rennie; R. Adams Dudley

doi:10.1016/j.jcrc.2010.06.010

Predictors of early postdischarge mortality in critically ill patients: A retrospective cohort study from the California Intensive Care Outcomes project

Eduard E. Vasilevskis, Michael W. Kuzniewicz, Brian A. Cason, Rondall K. Lane, Mitzi L. Dean, Ted Clay, Deborah J. Rennie, R. Adams Dudley

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	65-75
Number of pages	11
Journal	Journal of Critical Care
Volume	26
Issue number	1
DOIs	https://doi.org/10.1016/j.jcrc.2010.06.010
State	Published - Feb 2011
Externally published	Yes

Bibliographical note

Funding 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 .

Keywords

Health services research
Hospital mortality
Intensive care unit
Outcome assessment (Health care)
Patient discharge
Transitions of Care

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jcrc.2010.06.010

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title = "Predictors of early postdischarge mortality in critically ill patients: A retrospective cohort study from the California Intensive Care Outcomes project",

abstract = "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.",

keywords = "Health services research, Hospital mortality, Intensive care unit, Outcome assessment (Health care), Patient discharge, Transitions of Care",

author = "Vasilevskis, {Eduard E.} and Kuzniewicz, {Michael W.} and Cason, {Brian A.} and Lane, {Rondall K.} and Dean, {Mitzi L.} and Ted Clay and Rennie, {Deborah J.} and Dudley, {R. Adams}",

note = "Funding 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 . ",

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doi = "10.1016/j.jcrc.2010.06.010",

language = "English (US)",

volume = "26",

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journal = "Journal of Critical Care",

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T1 - Predictors of early postdischarge mortality in critically ill patients

T2 - A retrospective cohort study from the California Intensive Care Outcomes project

AU - Vasilevskis, Eduard E.

AU - Kuzniewicz, Michael W.

AU - Cason, Brian A.

AU - Lane, Rondall K.

AU - Dean, Mitzi L.

AU - Clay, Ted

AU - Rennie, Deborah J.

AU - Dudley, R. Adams

N1 - Funding 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 .

PY - 2011/2

Y1 - 2011/2

N2 - 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.

AB - 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.

KW - Health services research

KW - Hospital mortality

KW - Intensive care unit

KW - Outcome assessment (Health care)

KW - Patient discharge

KW - Transitions of Care

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Predictors of early postdischarge mortality in critically ill patients: A retrospective cohort study from the California Intensive Care Outcomes project

Abstract

Bibliographical note

Keywords

UN SDGs

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