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在不列颠哥伦比亚省,重症监护病房幸存者的医院再入院率和再入院天数比其他住院患者少。

Intensive care unit survivors have fewer hospital readmissions and readmission days than other hospitalized patients in British Columbia.

作者信息

Keenan Sean P, Dodek Peter, Chan Keith, Simon Mathieu, Hogg Robert S, Anis Aslam H, Spinelli John J, Tilley Jessica, Norena Monica, Wong Hubert

机构信息

Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, B.C., Canada.

出版信息

Crit Care Med. 2004 Feb;32(2):391-8. doi: 10.1097/01.CCM.0000108882.65743.91.

Abstract

OBJECTIVE

Intensive care unit (ICU) patients who survive their hospital admission have a long-term survival that is similar to that of hospitalized patients who do not require ICU admission. The risk of future readmission to the hospital for these two patient groups is unknown. The objective of this study was to determine the association between ICU admission and number of readmissions to the hospital and number of readmission days.

DESIGN

Cohort study for 3 yrs between 1994 and 1997.

SETTING

All acute care hospitals in British Columbia, Canada.

PATIENTS

A total of 23,859 patients admitted to the ICU and 40,052 patients admitted to the hospital but not the ICU (5% random sample of total).

INTERVENTION

None.

MEASUREMENTS AND MAIN RESULTS

We measured the number of readmissions to the hospital and the number of readmission days after discharge from the first admission to the hospital during the study period. For survivors to the end of the study period, patients who had been in the ICU had 0.66 readmissions per year and 5.29 readmission days per year compared with 0.73 readmissions per year and 5.48 readmission days per year for control subjects. After controlling for age, sex, socioeconomic status, number of previous ICU and hospital admissions, major clinical category during index admission, comorbidity score during index admission, length of hospital stay during index admission, size of index hospital, and period of follow-up, ICU admission was associated with fewer readmissions (survivors: rate ratio, 0.80; 95% confidence interval, 0.77-0.82; nonsurvivors: rate ratio, 0.85; 95%, confidence interval, 0.82-0.89) and readmission days (survivors: rate ratio, 0.91; 95% confidence interval, 0.87-0.95; nonsurvivors: rate ratio, 0.87; 95%, confidence interval, 0.81-0.92) than admission to the hospital but not the ICU.

CONCLUSIONS

Survivors of a hospital stay that includes admission to an ICU have fewer hospital readmissions and readmission days after their discharge than do survivors of a hospital stay without intensive care.

摘要

目的

在医院住院治疗后存活的重症监护病房(ICU)患者的长期生存率与未入住ICU的住院患者相似。这两组患者未来再次入院的风险尚不清楚。本研究的目的是确定入住ICU与再次入院次数及再次入院天数之间的关联。

设计

1994年至1997年的3年队列研究。

地点

加拿大不列颠哥伦比亚省的所有急症护理医院。

患者

共有23859例入住ICU的患者和40052例入住医院但未入住ICU的患者(占总数的5%随机样本)。

干预措施

无。

测量指标及主要结果

我们测量了研究期间从首次入院出院后再次入院的次数及再次入院天数。对于研究期结束时的幸存者,入住ICU的患者每年有0.66次再次入院,每年有5.29天再次入院,而对照组患者每年有0.73次再次入院,每年有5.48天再次入院。在控制了年龄、性别、社会经济状况、既往入住ICU和医院的次数、首次入院时的主要临床类别、首次入院时的合并症评分、首次入院时的住院时间、首次入院医院规模以及随访时间后,入住ICU与再次入院次数较少(幸存者:率比为0.80;95%置信区间为0.77 - 0.82;非幸存者:率比为0.85;95%置信区间为0.82 - 0.89)和再次入院天数较少(幸存者:率比为0.91;95%置信区间为0.87 - 0.95;非幸存者:率比为0.87;95%置信区间为0.81 - 0.92)相关,低于入住医院但未入住ICU的情况。

结论

住院期间包括入住ICU的幸存者出院后的再次入院次数及再次入院天数少于未接受重症监护的住院幸存者。

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