Predictors of early postdischarge mortality in critically ill patients: A retrospective cohort study from the California Intensive Care Outcomes project

Vasilevskis, Eduard E.; Kuzniewicz, Michael W.; Cason, Brian A.; Lane, Rondall K.; Dean, Mitzi L.; Clay, Ted; Rennie, Deborah J.; Dudley, R. Adams

doi:10.1016/j.jcrc.2010.06.010

« Previous Next »Journal of Critical Care
Volume 26, Issue 1 , Pages 65-75, February 2011

Predictors of early postdischarge mortality in critically ill patients: A retrospective cohort study from the California Intensive Care Outcomes project☆☆☆★

Eduard E. Vasilevskis, MD
- Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, CA, USA
- Division of Hospital Medicine, University of California at San Francisco, San Francisco, CA, USA
- Department of Medicine (General Internal Medicine and Public Health), Vanderbilt University, Nashville, TN, USA
- Geriatric Research Education and Clinical Center (GRECC), Veterans Administration, Tennessee Valley Healthcare System, Nashville, TN, USA
- Clinical Research Training Center of Excellence (CRCoE), Veterans Administration, Tennessee Valley Healthcare System, Nashville, TN, USA
- Corresponding author. Vanderbilt University Medical Center, 6006 Medical Center East, NT, Nashville, TN 37232-8300, USA. Tel.: +1 615 936 1935; fax: +1 615 936 1269.
Michael W. Kuzniewicz, MD, MPH
- Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA
- Division of Neonatology, University of California at San Francisco, San Francisco, CA, USA
Brian A. Cason, MD
- Department of Anesthesiology and Perioperative Care, University of California at San Francisco, San Francisco, CA, USA
- Veterans Affairs Medical Center, San Francisco, CA, USA
Rondall K. Lane, MD, MPH
- Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA
- Department of Anesthesiology and Perioperative Care, University of California at San Francisco, San Francisco, CA, USA
Mitzi L. Dean, MS, MHA
- Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA
Ted Clay, MS
- Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA
Deborah J. Rennie, BA
- Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA
R. Adams Dudley, MD, MBA
- Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA
- Division of Pulmonary and Critical Care Medicine, University of California at San Francisco, San Francisco, CA, USA

published online 18 August 2010.

Abstract

Purpose

Existing intensive care unit (ICU) mortality measurement systems address in-hospital mortality only. However, early postdischarge mortality contributes significantly to overall 30-day mortality. Factors associated with early postdischarge mortality are unknown.

Methods

We performed a retrospective study of 8484 ICU patients. Our primary outcome was early postdischarge mortality: death after hospital discharge and 30 days or less from ICU admission. Cox regression models assessed the association between patient, hospital, and utilization factors and the primary outcome.

Results

In multivariate analyses, the hazard for early postdischarge mortality increased with rising severity of illness and decreased with full-code status (hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.21-0.49). Compared with discharges home, early postdischarge mortality was highest for acute care transfers (HR, 3.18; 95% CI, 2.45-4.12). Finally, patients with very short ICU length of stay (<1 day) had greater early postdischarge mortality (HR, 1.86; 95% CI; 1.32-2.61) than those with longest stays (≥7 days).

Conclusions

Early postdischarge mortality is associated with patient preferences (full-code status) and decisions regarding timing and location of discharge. These findings have important implications for anyone attempting to measure or improve ICU performance and who rely on in-hospital mortality measures to do so.

Keywords: Intensive care unit, Hospital mortality, Patient discharge, Outcome assessment (Health care), Health services research, Transitions of Care

To access this article, please choose from the options below

☆ Work was performed at the University of California, San Francisco, San Francisco, CA.

☆☆ Conflicts of Interest: The authors have no conflicts of interest to disclose.

★ Disclaimers: The views expressed in this article are those of the authors and do not necessarily represent the views of the US Department of Veterans Affairs.

PII: S0883-9441(10)00173-5

doi:10.1016/j.jcrc.2010.06.010

Published by Elsevier Inc.

« Previous Next »Journal of Critical Care
Volume 26, Issue 1 , Pages 65-75, February 2011

Access this article on SciVerse ScienceDirect