National Trends and Variation of Functional Status Deterioration in the Medically Critically Ill

Abstract

Objectives: Physical and psychologic deficits after an ICU admission are associated with lower quality of life, higher mortality, and resource utilization. This study aimed to examine the prevalence and secular changes of functional status deterioration during hospitalization among nonsurgical critical illness survivors over the past decade.

Design: We performed a retrospective longitudinal cohort analysis.

Setting: Analysis performed using the Cerner Acute Physiology and Chronic Health Evaluation outcomes database which included manually abstracted data from 236 U.S. hospitals from 2008 to 2016.

Patients: We included nonsurgical adult ICU patients who survived their hospitalization and had a functional status documented at ICU admission and hospital discharge. Physical functional status was categorized as fully independent, partially dependent, or fully dependent.

Interventions: None.

Measurements and main results: Functional status deterioration occurred in 38,116 patients (29.3%). During the past decade, functional status deterioration increased in each disease category, as well as overall (prevalence rate ratio, 1.15; 95% CI, 1.13-1.17; p < 0.001). Magnitude of functional status deterioration also increased over time (odds ratio, 1.03; 95% CI, 1.03-1.03; p < 0.001) with hematological, sepsis, neurologic, and pulmonary disease categories having the highest odds of severe functional status deterioration.

Conclusions: Following nonsurgical critical illness, the prevalence of functional status deterioration and magnitude increased in a nationally representative cohort, despite efforts to reduce ICU dysfunction over the past decade. Identifying the prevalence of functional status deterioration and primary etiologies associated with functional status deterioration will elucidate vital areas for further research and targeted interventions. Reducing ICU debilitation for key disease processes may improve ICU survivor mortality, enhance quality of life, and decrease healthcare utilization.

Figure 1:

Inclusion and Exclusion Criteria Inclusion and Exclusion Criteria

Figure 2:

Incidence of Functional Status Deterioration by Admission Disease-System Category Functional Status Decline by admission disease category. Functional status was categorized as no decline or decline. IRR is per year.

Figure 3:

Magnitude of Functional Status Deterioration by Admission Disease-System Category Functional Status Decline by admission category with an ordinal model showing magnitude of functional status decline overtime. Functional status category was split into no change, independent to partially dependent, partially dependent to full dependent, and independent to fully dependent. Sum-to-zero parameterization was implemented to compare the odds for each disease group against the overall odds of FS↓. FS↓ = Functional status decline, CI = Confidence Interval

Figure 4:

Magnitude of Functional Status Deterioration by Admission Diagnosis Decline in functional status magnitude by admission diagnosis. COPD = Chronic Obstructive Lung Disease; NOS = Not otherwise specified; GI = Gastrointestinal; MSK = Musculoskeletal; MI = Myocardial Infarction; DKA = Diabetic ketoacidosis Reference group is respiratory failure NOS.