Long-term outcomes and healthcare utilization following critical illness - a population-based study
Long-term outcomes and healthcare utilization following critical illness - a population-based study
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DOI：
10.1186/s13054-016-1248-y
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发表时间：
2016-03-31
期刊：
影响因子：
15.1
通讯作者：
Scales, D. C.
中科院分区：
文献类型：
--
作者：
Hill, A. D.;Fowler, R. A.;Scales, D. C.
背景资料：本研究的目的是探讨医院死亡率，长期死亡率，和卫生服务利用的危重病人。我们还根据人口统计学和临床特征确定这些结果是否不同。我们对2002年4月1日至2012年3月31日期间在加拿大安大略入住重症监护室（ICU）后存活的成人（年龄≥ 18岁）进行了一项回顾性队列研究，排除了单独入住降压或中级ICU、冠状动脉护理ICU或心脏手术ICU的患者。急性住院（不包括ICU住院）存活的成人（年龄≥ 18岁）组成对照组。主要结局是出院后的死亡率。次要结果是医疗保健利用率，包括急诊室入院和随访期间的再入院率。结果：在研究期间，500，124例患者入住ICU，420，187例（84%）存活至出院。存活者的中位随访时间为5.3（四分位距2.5，8.2）年。入住ICU的患者更有可能随后前往急诊科，再次入院和ICU，接受家庭护理支持，需要康复，并接受长期护理。那些在ICU内需要更多资源的人在出院后需要更多资源。三分之一入住ICU的患者在长期随访期间死亡，1年和5年的总死亡概率分别为11%和29%。在校正分析中，随着年龄的增加，死亡风险增加，风险比达到18.08（95%置信区间16.60-19.68）与年龄在18-24岁之间的人相比，年龄>= 85岁的人更容易患乳腺癌。ICU患者出院后的医疗保健利用率较高，并且在那些在ICU住院期间需要更多医疗保健资源的患者中，也比所有住院患者作为一个群体。三分之一的ICU患者在出院后5年内死亡，年龄是最有影响力的结局决定因素。这些发现应该有助于针对高危人群的ICU后出院服务，并更好地为老年重症患者的护理目标讨论提供信息。
Background: The purpose of this study was to examine hospital mortality, long-term mortality, and health service utilization among critically ill patients. We also determined whether these outcomes differed according to demographic and clinical characteristics.Methods: We conducted a retrospective cohort study of adults (age >= 18 years) who survived admission to an intensive care unit (ICU) in Ontario, Canada, between 1 April 2002 and 31 March 2012, excluding isolated admissions to step-down or intermediate ICUs, coronary care ICUs, or cardiac surgery ICUs. Adults (age >= 18 years) who survived an acute hospitalization that did not include an ICU stay formed the comparator group. The primary outcome was mortality following hospital discharge. Secondary outcomes were healthcare utilization, including emergency room admissions and hospital readmissions during follow-up.Results: Over the study interval, 500,124 patients were admitted to ICUs and 420,187 (84 %) survived to hospital discharge. Median follow-up for survivors was 5.3 (interquartile range 2.5, 8.2) years. Patients admitted to an ICU were more likely to subsequently visit the emergency department, be readmitted to the hospital and ICU, receive home care support, require rehabilitation, and be admitted for long-term care. Those requiring more resources within the ICU required more resources after discharge. One-third of patients admitted to the ICU died during long-term follow-up, with overall probabilities of death of 11 % and 29 % at 1 year and 5 years, respectively. In the adjusted analysis, there was an increasing hazard of death with increasing age, reaching a hazard ratio of 18.08 (95 % confidence interval 16.60-19.68) for those >= 85 years of age compared with those aged 18-24 years.Conclusions: Healthcare utilization after hospital discharge was higher among ICU patients, and also among those requiring more healthcare resources during their ICU admission, than among all hospitalized patients as a group. One-third of ICU patients died within the 5 years following discharge, and age was the most influential determinant of outcome. These findings should help target post-ICU discharge services for high-risk groups and better inform goals-of-care discussions for elderly critically ill patients.