Aryal Diptesh, Paneru Hem Raj, Koirala Sabin, Khanal Sushil, Acharya Subhash Prasad, Karki Arjun, Dona Dilanthi Gamaga, Haniffa Rashan, Beane Abi, Salluh Jorge I F
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Nepal Intensive Care Research Foundation, Kathmandu, Nepal.
Wellcome Open Res. 2025 Feb 24;7:272. doi: 10.12688/wellcomeopenres.18381.3. eCollection 2022.
Readmissions to Intensive Care Units (ICUs) result in increased morbidity, mortality, and ICU resource utilisation (e.g. prolonged mechanical ventilation), and as such, is a widely utilised metric of quality of critical care. Most of the evidence on incidence, characteristics, associated risk factors and attributable outcomes of readmission to ICU are from studies performed in high-income countries This study explores the determinants of risk attributable to ICU readmission in four ICUs in Kathmandu, Nepal.
The registry reported data on case mix, severity of illness, in-ICU interventions (including organ support), ICU outcome, and readmission characteristics. Data were captured in all adult patients admitted between September 2019 and February 2021. Population and ICU encounter characteristics were compared between those with and without readmission. Independent risk factors for readmission were assessed using univariate analysis.
In total 2955 patients were included in the study. Absolute ICU readmission rate was 5.69 % (n=168) for all four ICUs. Median time from ICU discharge to readmission was 3 days (IQR=8,1). Of those readmitted, 29.17% (n=49) were discharged at night following their index admission. ICU mortality was higher following readmission to ICU(p=0.016) and mortality was increased further in patients whose primary index discharge was at night(p= 0.019). Primary diagnosis, age, and use of organ support in the first 24hrs of index admission were all independently attributable risk factors for readmission.
ICU readmission rates were adversely associated with significantly poorer outcomes, increased ICU resource utilisation. Clinical and organisational characteristics influenced risk of readmission and outcome.
重症监护病房（ICU）再入院会导致发病率、死亡率增加以及ICU资源利用增加（例如机械通气时间延长），因此，这是广泛用于衡量重症监护质量的指标。关于ICU再入院的发生率、特征、相关危险因素和可归因结果的大多数证据来自高收入国家进行的研究。本研究探讨了尼泊尔加德满都四个ICU中ICU再入院可归因风险的决定因素。
登记处报告了病例组合、疾病严重程度、ICU内干预措施（包括器官支持）、ICU结局和再入院特征的数据。收集了2019年9月至2021年2月期间所有成年住院患者的数据。比较了有再入院和无再入院患者的人群和ICU就诊特征。使用单因素分析评估再入院的独立危险因素。
该研究共纳入2955例患者。所有四个ICU的绝对ICU再入院率为5.69%（n=168）。从ICU出院到再入院的中位时间为3天（IQR=8,1）。在再入院患者中，29.17%（n=49）在首次入院后夜间出院。再次入住ICU后ICU死亡率更高（p=0.016），首次出院在夜间的患者死亡率进一步增加（p=0.019）。首次入院后24小时内的主要诊断、年龄和器官支持的使用都是再入院的独立可归因危险因素。
ICU再入院率与明显较差的结局、ICU资源利用增加呈负相关。临床和组织特征影响再入院风险和结局。
