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. 2016 Apr;44(4):655-62.
doi: 10.1097/CCM.0000000000001480.

Relationship Between ICU Length of Stay and Long-Term Mortality for Elderly ICU Survivors

Vivek K Moitra  1 , Carmen Guerra, Walter T Linde-Zwirble, Hannah Wunsch
Affiliations

Relationship Between ICU Length of Stay and Long-Term Mortality for Elderly ICU Survivors

Vivek K Moitra et al. Crit Care Med. 2016 Apr.

Abstract

Objectives: To evaluate the association between length of ICU stay and 1-year mortality for elderly patients who survived to hospital discharge in the United States.

Design: Retrospective cohort study of a random sample of Medicare beneficiaries who survived to hospital discharge, with 1- and 3-year follow-up, stratified by the number of days of intensive care and with additional stratification based on receipt of mechanical ventilation.

Interventions: None.

Patients: The cohort included 34,696 Medicare beneficiaries older than 65 years who received intensive care and survived to hospital discharge in 2005.

Measurements and main results: Among 34,696 patients who survived to hospital discharge, the mean ICU length of stay was 3.4 days (± 4.5 d). Patients (88.9%) were in the ICU for 1-6 days, representing 58.6% of ICU bed-days. Patients (1.3%) were in the ICU for 21 or more days, but these patients used 11.6% of bed-days. The percentage of mechanically ventilated patients increased with increasing length of stay (6.3% for 1-6 d in the ICU and 71.3% for ≥ 21 d). One-year mortality was 26.6%, ranging from 19.4% for patients in the ICU for 1 day, up to 57.8% for patients in the ICU for 21 or more days. For each day beyond 7 days in the ICU, there was an increased odds of death by 1 year of 1.04 (95% CI, 1.03-1.05) irrespective of the need for mechanical ventilation.

Conclusions: Increasing ICU length of stay is associated with higher 1-year mortality for both mechanically ventilated and non-mechanically ventilated patients. No specific cutoff was associated with a clear plateau or sharp increase in long-term risk.

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Figures

Figure 1
Figure 1
Patient flowchart of cohort of ICU survivors
Figure 2
Figure 2
Distribution of Medicare beneficiaries who survived to hospital discharge, and proportion of total bed days, stratified by length of stay in ICU
Figure 3
Figure 3
Percentage of Medicare beneficiaries who survived to hospital discharge who received mechanical ventilation, stratified by length of stay in the ICU
Figure 4
Figure 4
1-year mortality for Medicare beneficiaries who received intensive care and survived to hospital discharge, by days in the ICU
Figure 5
Figure 5
1-year mortality for Medicare beneficiaries who received intensive care and survived to hospital discharge, stratified by days in the ICU and whether or not patients received invasive mechanical ventilation
See this image and copyright information in PMC

Comment in

References

    1. Nelson JE, Cox CE, Hope AA, Carson SS. Chronic critical illness. Am J Respir Crit Care Med. 182:446–454. - PMC - PubMed
    1. Estenssoro E, Reina R, Canales HS, Saenz MG, Gonzalez FE, Aprea MM, Laffaire E, Gola V, Dubin A. The distinct clinical profile of chronically critically ill patients: A cohort study. Crit Care. 2006;10:R89. - PMC - PubMed
    1. Hartl WH, Wolf H, Schneider CP, Kuchenhoff H, Jauch KW. Acute and long-term survival in chronically critically ill surgical patients: A retrospective observational study. Crit Care. 2007;11:R55. - PMC - PubMed
    1. Goins WA, Reynolds HN, Nyanjom D, Dunham CM. Outcome following prolonged intensive care unit stay in multiple trauma patients. Crit Care Med. 1991;19:339–345. - PubMed
    1. Gracey DR, Naessens JM, Krishan I, Marsh HM. Hospital and posthospital survival in patients mechanically ventilated for more than 29 days. Chest. 1992;101:211–214. - PubMed

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