Readmissions to Intensive Care: A Prospective Multicenter Study in Australia and New Zealand
Readmissions to Intensive Care: A Prospective Multicenter Study in Australia and New Zealand
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DOI：
10.1097/ccm.0000000000002066
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发表时间：
2017-02-01
影响因子：
8.8
通讯作者：
Bellomo, Rinaldo
中科院分区：
文献类型：
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作者：
Santamaria, John D.;Duke, Graeme J.;Bellomo, Rinaldo
目的：确定与再入 ICU 独立相关的因素以及再入院与随后死亡率的独立关联。设计：前瞻性多中心观察性研究。地点：澳大利亚和新西兰的 40 个 ICU。患者：2009 年 9 月至 2010 年 2 月期间连续从 ICU 存活到医院病房的成年患者。干预措施：医院死亡率的测量。测量和主要结果：我们研究了 10,210 名患者和 674 名患者重新入院。中位年龄为 63 岁（四分位数范围为 49-74 岁），其中 6,224 名 (61%) 为男性。大多数再入院是计划外的（84.1%），但只有少数（8.9%）病例被认为是可以预防的。非计划再入院的首次再入院时间比计划再入院的时间短（3.2 天 vs 6.9 天；p < 0.001）。大多数患者（60.2%）在入院和再入院之间的主要诊断发生了变化，无论是计划状态（58.2%）还是非计划状态（60.6%）。通过结合患者虚弱的复发事件分析，我们发现再入院与医院生存之间没有关联（风险比：第一次再入院 0.88，第二次再入院 0.90，第三次再入院 0.44；p > 0.05）。相比之下，年龄（风险比，1.03）、医学诊断（风险比，1.43）、正性肌力药的使用（风险比，3.47）和治疗限制令（风险比，17.8）均与结果独立相关。结论：在这项大型前瞻性研究中，再入ICU并不是死亡的独立危险因素。
Objectives: To determine factors independently associated with readmission to ICU and the independent association of readmission with subsequent mortality.Design: Prospective multicenter observational study.Setting: Forty ICUs in Australia and New Zealand.Patients: Consecutive adult patients discharged alive from ICU to hospital wards between September 2009 and February 2010.Interventions: Measurement of hospital mortality.Measurements and Main Results: We studied 10,210 patients and 674 readmissions. The median age was 63 years (interquartile range, 49-74), and 6,224 (61%) were male. The majority of readmissions were unplanned (84.1%) but only deemed preventable in a minority (8.9%) of cases. Time to first readmission was shorter for unplanned than planned readmission (3.2 vs 6.9 d; p < 0.001). Primary diagnosis changed between admission and readmission in the majority of patients (60.2%) irrespective of planned (58.2%) or unplanned (60.6%) status. Using recurrent event analysis incorporating patient frailty, we found no association between readmissions and hospital survival (hazard ratios: first readmission 0.88, second readmission 0.90, third readmission 0.44; p > 0.05). In contrast, age (hazard ratio, 1.03), a medical diagnosis (hazard ratio, 1.43), inotrope use (hazard ratio, 3.47), and treatment limitation order (hazard ratio, 17.8) were all independently associated with outcome.Conclusions: In this large prospective study, readmission to ICU was not an independent risk factor for mortality.