College of Nursing, Dong-A University, Busan, South Korea.
Industry-Academy Cooperation, Dong-A University, Busan, South Korea.
Aust Crit Care. 2024 Mar;37(2):251-257. doi: 10.1016/j.aucc.2023.07.036. Epub 2023 Aug 12.
Due to the increasing number of critical care survivors, population-based studies on the long-term outcomes after discharge are necessary to inform local decision-making.
This study aimed to investigate mortality and its risk factors, readmissions, and medical expenses of intensive care unit survivors for 3 years after hospital discharge.
This retrospective study analysed data from the National Health Insurance Service-National Sample Cohort in Korea. Of the 195,702 patients who survived and were discharged from hospital in 2012, 2693 intensive care unit patients were assigned to the case group for the study, and the remaining 193,009 were assigned to the comparison group. The primary outcome was all-cause mortality for 3 years after discharge. Secondary outcomes were all-cause hospital readmission and medical expenses in 3 years. We analysed risk factors for mortality using the Cox proportional hazard regression. The differences in hospital readmission and medical expenses between the case and comparison groups were analysed by multivariate logistic regression and independent t-tests.
The 1-year, 2-year, and 3-year cumulative mortality rates in the case group were 15.9%, 20.5%, and 24.4%, respectively, and older age, disability, medical admission, and longer hospital stay increased mortality. Almost 40% of intensive care unit survivors were readmitted to hospital within 6 months of discharge, and their odds of being readmitted were significantly higher than those of the comparison group. Medical expenses were also significantly higher in the case group, with the highest paid within 6 months.
Mortality, hospital readmission, and medical expenses for intensive care unit survivors were the worst within 6 months of discharge. In light of the long-term recovery trajectory of critical illness, it is necessary to investigate what factors may have contributed to the negative outcome during this period. Further research is needed to determine which services primarily contributed to the increase in medical expenses.
由于重症监护幸存者人数不断增加，有必要进行基于人群的出院后长期结局研究，以为当地决策提供信息。
本研究旨在调查重症监护病房幸存者出院后 3 年内的死亡率及其危险因素、再入院和医疗费用。
这是一项回顾性研究，分析了来自韩国国家健康保险服务-全国抽样队列的资料。在 2012 年存活并出院的 195702 名患者中，2693 名重症监护病房患者被分配到病例组进行研究，其余 193009 名患者被分配到对照组。主要结局为出院后 3 年内的全因死亡率。次要结局为出院后 3 年内的全因再入院和医疗费用。我们使用 Cox 比例风险回归分析死亡率的危险因素。通过多变量逻辑回归和独立 t 检验分析病例组和对照组之间的医院再入院和医疗费用差异。
病例组的 1 年、2 年和 3 年累积死亡率分别为 15.9%、20.5%和 24.4%，年龄较大、残疾、医疗入院和住院时间延长均增加了死亡率。几乎 40%的重症监护病房幸存者在出院后 6 个月内再次入院，其再次入院的可能性明显高于对照组。病例组的医疗费用也明显较高，其中 6 个月内的费用最高。
重症监护病房幸存者出院后 6 个月内的死亡率、再入院率和医疗费用最差。鉴于危重病的长期恢复轨迹，有必要调查在此期间哪些因素可能导致了不良结局。需要进一步研究确定哪些服务主要导致了医疗费用的增加。
