COMMENTARY

Can We Predict Rehospitalization After an ICU Admission?

Alex Macario, MD, MBA

Disclosures

February 19, 2015

Early and Late Unplanned Rehospitalizations for Survivors of Critical Illness

Hua M, Gong MN, Brady J, Wunsch H
Crit Care Med. 2015;43:430-438

Study Summary

Approximately 8 million people in the United States are admitted to an intensive care unit (ICU) annually[1]; however, little is known about rehospitalization of these patients after discharge. This retrospective cohort study evaluated data from an administrative database of all hospital discharges in New York State to determine the frequency of rehospitalization after an ICU admission, outcomes for rehospitalized patients, and risk factors associated with rehospitalization. Overall, the authors identified 492,653 medical and surgical ICU patients discharged in 2008-2010.

Overall, 16.2% of these patients were rehospitalized within 30 days, and 18.9% were rehospitalized sometime between 31 and 180 days after their initial discharge. The most common reasons for rehospitalization were congestive heart failure, sepsis, "complications from a procedure or medical care," cardiac arrhythmias, and pneumonia. Longer length of stay during initial hospitalization (adjusted hazard ratio [aHR], 1.91 for length of stay >14 days) and discharge to a skilled nursing facility vs discharge to home (aHR, 1.54) were associated with the greatest risk for rehospitalization. Additionally, mechanical ventilation with a tracheostomy, dialysis, and severe sepsis during initial hospitalization significantly increased risk for rehospitalization. All-cause mortality for patients who were rehospitalized was 7.6% and was even higher at 15.7% for patients who received ICU care during the rehospitalization.

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