Department of Intensive Care, Allamanda Private Hospital, Southport, QLD, Australia.
Intensive Care Med. 2011 Nov;37(11):1800-8. doi: 10.1007/s00134-011-2318-x. Epub 2011 Aug 16.
To determine the epidemiology, in-hospital mortality, trends, patient characteristics and predictors of intensive care unit (ICU) readmission in Australia.
A retrospective longitudinal study of data for 38 Australian ICUs extracted from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS-ADP) for the years 2000-2007. Demographic, diagnostic, physiological and outcome data were analysed. A multivariate model was constructed to identify risk factors for ICU readmission. Outcomes examined included observed and risk-adjusted in-hospital mortality.
A total of 247,103 patients were discharged alive from their first ICU admission; 13,598 (5.5%) were readmitted at least once. Variables associated with an odds ratio greater than 1.05 for readmission (p < 0.001) were an initial ICU admission source other than elective surgery, any chronic health variable on severity scoring, tertiary hospital ICU and discharge between 6 p.m. and 6 a.m. Five initial diagnoses were associated with an odds ratio (OR) greater than 2 for readmission (p < 0.001). In-hospital mortality in readmitted patients was 20.7% compared with 4.4% in those not readmitted. Readmission rates have not changed over the study period. After adjustment for illness severity and readmission propensity, ICU readmission remained significantly associated with in-hospital mortality (OR 5.4, 95%, confidence interval (CI) 5.1-5.7).
Many risk factors for increased ICU readmission were identified in this study including ICU discharge between 6 p.m. and 6 a.m. This was the only modifiable variable studied. Prospective studies are required to identify other factors and to determine whether interventions may reduce ICU readmission and its high associated in-hospital mortality.
确定澳大利亚的流行病学、院内死亡率、趋势、患者特征和重症监护病房（ICU）再入院的预测因素。
这是一项对 2000 年至 2007 年澳大利亚和新西兰重症监护学会成人患者数据库（ANZICS-ADP）中 38 个澳大利亚 ICU 提取的数据进行的回顾性纵向研究。分析了人口统计学、诊断、生理学和结果数据。建立了一个多变量模型来确定 ICU 再入院的危险因素。检查的结果包括观察到的和风险调整后的院内死亡率。
共有 247103 名患者从首次 ICU 入院中存活出院；其中 13598 人（5.5%）至少再入院一次。与再入院几率比大于 1.05（p < 0.001）相关的变量是初始 ICU 入院来源不是择期手术、严重程度评分中有任何慢性健康变量、三级医院 ICU 和下午 6 点至上午 6 点之间出院。有五个初始诊断与再入院几率比大于 2（p < 0.001）相关。再入院患者的院内死亡率为 20.7%，而未再入院患者的院内死亡率为 4.4%。在研究期间，再入院率没有变化。在调整疾病严重程度和再入院倾向后，ICU 再入院与院内死亡率仍显著相关（OR 5.4，95%置信区间（CI）5.1-5.7）。
本研究确定了许多增加 ICU 再入院的危险因素，包括下午 6 点至上午 6 点之间的 ICU 出院。这是唯一研究的可改变变量。需要前瞻性研究来确定其他因素，并确定干预措施是否可以降低 ICU 再入院及其高相关的院内死亡率。
