Hua May, Gong Michelle Ng, Brady Joanne, Wunsch Hannah
1Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY. 2Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY. 3Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY. 4Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. 5Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 6Department of Anesthesiology, University of Toronto, Toronto, ON, Canada.
Crit Care Med. 2015 Feb;43(2):430-8. doi: 10.1097/CCM.0000000000000717.
Preventing rehospitalizations for patients with serious chronic illnesses is a focus of national quality initiatives. Although 8 million people are admitted yearly to an ICU, the frequency of rehospitalizations (readmissions to the hospital after discharge) is unknown. We sought to determine the frequency of rehospitalization after an ICU stay, outcomes for rehospitalized patients, and factors associated with rehospitalization.
Retrospective cohort study using the New York Statewide Planning and Research Cooperative System, an administrative database of all hospital discharges in New York State.
ICUs in New York State.
ICU patients who survived to hospital discharge in 2008-2010.
None.
Primary outcome was the cumulative incidence of first early rehospitalization (within 30 days of discharge), and secondary outcome was the cumulative incidence of late rehospitalization (between 31 and 180 d). Factors associated with rehospitalization within both time periods were identified using competing risk regression models. Of 492,653 ICU patients, 79,960 had a first early rehospitalization (cumulative incidence, 16.2%) and an additional 73,250 late rehospitalizations (cumulative incidence, 18.9%). Over one quarter of all rehospitalizations (28.6% for early; 26.7% for late) involved ICU admission. Overall hospital mortality for rehospitalized patients was 7.6% for early and 4.6% for late rehospitalizations. Longer index hospitalization (adjusted hazard ratio, 1.61; 95% CI, 1.57-1.66 for 7-13 d vs < 3 d), discharge to a skilled nursing facility versus home (adjusted hazard ratio, 1.54; 95% CI, 1.51-1.58), and having metastatic cancer (adjusted hazard ratio, 1.46; 95% CI, 1.41-1.51) were associated with the greatest hazard of early rehospitalization.
Approximately 16% of ICU survivors were rehospitalized within 30 days of hospital discharge; rehospitalized patients had high rates of ICU admission and hospital mortality. Few characteristics were strongly associated with rehospitalization, suggesting that identifying high-risk individuals for intervention may require additional predictors beyond what is available in administrative databases.
预防重症慢性病患者再次住院是国家质量改进计划的重点。尽管每年有800万人入住重症监护病房（ICU），但再次住院（出院后再次入院）的频率尚不清楚。我们试图确定ICU住院后再次住院的频率、再次住院患者的结局以及与再次住院相关的因素。
采用纽约州全州规划与研究合作系统进行回顾性队列研究，该系统是纽约州所有医院出院情况的行政数据库。
纽约州的ICU。
2008 - 2010年存活至出院的ICU患者。
无。
主要结局是首次早期再次住院（出院后30天内）的累积发生率，次要结局是晚期再次住院（31至180天之间）的累积发生率。使用竞争风险回归模型确定两个时间段内与再次住院相关的因素。在492,653例ICU患者中，79,960例有首次早期再次住院（累积发生率为16.2%），另有73,250例晚期再次住院（累积发生率为18.9%）。所有再次住院患者中超过四分之一（早期为28.6%；晚期为26.7%）涉及ICU入院。再次住院患者的总体医院死亡率早期为7.6%，晚期为4.6%。较长的首次住院时间（调整后风险比，1.61；7 - 13天与<3天相比，95%置信区间为1.57 - 1.66）、出院至专业护理机构而非家中（调整后风险比，1.54；95%置信区间为1.51 - 1.58）以及患有转移性癌症（调整后风险比，1.46；95%置信区间为1.41 - 1.51）与早期再次住院的最大风险相关。
约16%的ICU幸存者在出院后30天内再次住院；再次住院患者的ICU入院率和医院死亡率较高。很少有特征与再次住院密切相关，这表明识别高危个体进行干预可能需要行政数据库之外的其他预测因素。
