Rosenberg A L, Zimmerman J E, Alzola C, Draper E A, Knaus W A
ICU Research, The Department of Anesthesiology and Critical Care Medicine, George Washington University Medical Center, Washington, DC 20037, USA.
Crit Care Med. 2000 Oct;28(10):3465-73. doi: 10.1097/00003246-200010000-00016.
To compare case-mix adjusted intensive care unit (ICU) length of stay for critically ill patients with a variety of medical and surgical diagnoses during a 5-yr interval.
Nonrandomized cohort study.
A total of 42 ICUs at 40 US hospitals during 1988-1990 and 285 ICUs at 161 US hospitals during 1993-1996.
A total of 17,105 consecutive ICU admissions during 1988-1990 and 38,888 consecutive ICU admissions during 1993-1996.
We used patient demographic and clinical characteristics to compare observed and predicted ICU length of stay and hospital mortality. Outcomes for patients studied during 1993-1996 were predicted using multivariable models that were developed and cross-validated using the 1988-1990 database. The mean observed hospital length of stay decreased by 3 days (from 14.8 days during 1988-1990 to 11.8 days during 1993-1996), but the mean observed ICU length of stay remained similar (4.70 vs. 4.53 days). After adjusting for patient and institutional differences, the mean predicted 1993-1996 ICU stay was 4.64 days. Thus, the mean-adjusted ICU stay decreased by 0.11 days during this 5-yr interval (T-statistic, 4.35; p < .001). The adjusted mean ICU length of stay was not changed for patients with 49 (75%) of the 65 ICU admission diagnoses. In contrast, the mean observed hospital length of stay was significantly shorter for 47 (72%) of the 65 admission diagnoses, and no ICU admission diagnosis was associated with a longer hospital stay. Aggregate risk-adjusted hospital mortality during 1993-1996 (12.35%) was not significantly different during 1988-1990 (12.27%, p = .54).
For patients admitted to ICUs, the pressures associated with a decrease in hospital length of stay do not seem to have influenced the duration of ICU stay. Because of the high cost of intensive care, reduction in ICU stay may become a target for future cost-cutting efforts.
比较5年期间患有各种内科和外科诊断疾病的危重症患者经病例组合调整后的重症监护病房（ICU）住院时间。
非随机队列研究。
1988 - 1990年期间美国40家医院的42个ICU，以及1993 - 1996年期间美国161家医院的285个ICU。
1988 - 1990年期间共有17105例连续入住ICU的患者，1993 - 1996年期间共有38888例连续入住ICU的患者。
我们使用患者的人口统计学和临床特征来比较观察到的和预测的ICU住院时间及医院死亡率。1993 - 1996年期间研究患者的结局是使用多变量模型预测的，这些模型是利用198年8 - 1990年的数据库开发并交叉验证的。观察到的平均住院时间缩短了3天（从1988 - 1990年的14.8天降至1993 - 1996年的11.8天），但观察到的平均ICU住院时间保持相似（4.70天对4.53天）。在对患者和机构差异进行调整后，1993 - 1996年预测的平均ICU住院时间为4.64天。因此，在这5年期间，经均值调整后的ICU住院时间缩短了0.11天（T统计量，4.35；p < 0.001）。65种ICU入院诊断中有49种（75%）诊断的患者，其调整后的平均ICU住院时间没有变化。相比之下，65种入院诊断中有47种（72%）诊断的患者，其观察到的平均住院时间显著缩短，且没有ICU入院诊断与更长的住院时间相关。1993 - 1996年期间经风险调整后的总体医院死亡率（12.35%）与1988 - 1990年期间（12.27%，p = 0.54）相比无显著差异。
对于入住ICU的患者，与住院时间缩短相关的压力似乎并未影响ICU住院时间。由于重症监护成本高昂，缩短ICU住院时间可能成为未来成本削减努力的目标。
