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. 2021 Dec 31;37(3):10.7196/SAJCC.2021.v37i3.500.
doi: 10.7196/SAJCC.2021.v37i3.500. eCollection 2021.

Association between pre-intensive care unit (ICU) hospital length of stay and ICU outcomes in a resource-limited setting

S Khan  1 , R Wise  1   2   3 , S M Savarimuthu  4 , G L Anesi  5
Affiliations

Association between pre-intensive care unit (ICU) hospital length of stay and ICU outcomes in a resource-limited setting

S Khan et al. South Afr J Crit Care. .

Abstract

Background: Previous studies demonstrated higher mortality for patients with a longer pre-intensive care unit (ICU) hospital length of stay (LOS), in well-resourced settings.

Objectives: The study aimed to determine the association between pre-ICU hospital LOS and ICU outcomes in a resource-limited setting. We hypothesised that longer pre-ICU hospital LOS would be associated with higher ICU mortality.

Methods: This was a retrospective cohort study measuring the association between pre-ICU hospital LOS and ICU outcomes using data extracted from a regional hospital ICU in KwaZulu-Natal, South Africa. Consecutive ICU admissions of all patients (medical and surgical) older than 18 years were included during the study period September 2014 to August 2018. A corrected sample size of 2 040 patients was identified. Multivariable logistic regression was used to assess the primary outcome of ICU mortality, and multivariable Cox proportional hazard regression was used for the secondary outcome of ICU LOS.

Results: The median pre-ICU hospital LOS was 1 day (interquartile range (IQR) 0 - 2 days). The median length of ICU stay was 2.4 days (IQR 1.1 - 4.8 days) and the observed ICU mortality was 16% (n=327/2 040). Pre-ICU hospital LOS was not associated with ICU mortality in the unadjusted (odds ratio (OR) 1.00; 95% confidence interval (CI) 0.98 - 1.02; p=0.68; n=2 040) and fully adjusted logistic regression models (OR 1.00; 95% CI 0.98 - 1.03; p=0.90; n=1 981) using a complete case analysis for missing patient-level covariates. In Cox proportional hazard models, there was no association between pre-ICU hospital LOS and ICU LOS (hazard ratio 1.00; 95% CI 0.98 - 1.03; p=0.72; n=1 967), including when stratified by admission source.

Conclusion: Pre-ICU hospital LOS was not associated with either ICU mortality or ICU LOS in a resource-limited setting. Future studies should aim to include multicentre data and evaluate long-term outcomes.

Contributions of the study: The study was conducted in a resource-limited setting and found no association between prolonged LOS pre-ICU and patient outcomes. Several potential explanations for this observation have been explored. This important subject is pertinent to the appropriate use of limited resources and encourages future studies to evaluate this association and to consider longer-term outcomes (e.g. 30-day mortality) in future findings.

Keywords: South Africa; intensive care; length of stay; mortality; outcome.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Fig. 1
Fig. 1
Flow diagram of study population sample. OT = operating theatre ED = emergency department ICU = intensive care unit LOS = length of stay
See this image and copyright information in PMC

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References

    1. Marshall JC, Bosco L, Adhikari NK, et al. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care. 2017;37:270–276. doi: 10.1016/j.jcrc.2016.07.015. - DOI - PubMed
    1. Cardoso LTQ, Grion CMC, Matsuo T, et al. Impact of delayed admission to intensive care units on mortality of critically ill patients: A cohort study. Crit Care. 2011;15(1):R28. doi: 10.1186/cc9975. - DOI - PMC - PubMed
    1. Flavin K, Hall D, Marshall G, Zolfaghari P. Pre-ICU length of hospital stay is a predictor of hospital but not ICU mortality. Crit Care. 2015;19(1):P527. doi: 10.1186/cc14607. - DOI
    1. Flabouris A, Jeyadoss J, Field J, Soulsby T. Direct and delayed admission to an intensive care or high dependency unit following discharge from the emergency department: Associated patient characteristics and hospital outcomes. Crit Care Resus. 2012;14(3):191–197. - PubMed
    1. Chiavone PA, Rasslan S. Influence of time elapsed from end of emergency surgery until admission to intensive care unit, on Acute Physiology and Chronic Health Evaluation II (APACHE II) prediction and patient mortality rate. Sao Paulo Med J. 2005;123:167–174. doi: 10.1590/s1516-31802005000400003. - DOI - PMC - PubMed

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