Impact of the premature discharge on hospital mortality after a stay in an intensive care unit

Rodríguez-Carvajal, M.; Mora, D.; Doblas, A.; García, M.; Domínguez, P.; Tristancho, A.; Herrera, M.

doi:10.1016/S2173-5727(11)70018-2

Información del artículo

Abstract

Objective

To determine the frequency and to evaluate the relationship between premature discharge and post-ICU hospital mortality.

Design

A prospective registry was made for patients admitted during six consecutive years, performing a retrospective analysis of the data on the first admission of ICU survivors.

Setting

A 10-bed general ICU in a 540-bed tertiary-care community hospital.

Patients

1,521 patients with an ICU stay longer than 12 hours, discharged alive to wards with known hospital outcome.

Interventions

None.

Main variables

We recorded the patient data, including types of ICU discharge, normal or premature, and studying their relationship with post-ICU hospital mortality. The types of ICU discharge were also evaluated versus ICU readmission rate and post-ICU length of stay.

Results

There were 165 patients (10.8%) with premature discharge. Mortality rate was 11.6% (176 patients). The factors related with mortality were withdrawal and limitation of lifesustaining treatments (OR=14.02 4.6–42.6), readmissions to ICU (OR=3.46 1.76–6.78), premature discharge (OR=2.6 1.06–4.41), higher organ failure score on discharge from the ICU (OR=1.16 1.01–1.32) and age (OR=1.03 1.01–1.05). Readmission rates and post-ICU length of stay were similar among patients with premature and normal discharge (7.3% vs. 8.2%, P=.68 and 16.7±16.7 days vs. 18.7±21.3 days, respectively, P=162).

Conclusions

Premature discharges appear to be common in our setting and have a significant impact on mortality. Types of ICU discharge do not seem to be related with other outcome variables in the hospital care of critically ill patients.

Keywords:

Intensive care unit

Patient discharge

Withdrawing treatment

In-hospital mortality

Patient readmission

Outcome

Resumen

Objetivos

Comprobar la frecuencia de altas no programadas y su relación con la mortalidad hospitalaria tras la estancia en UCI.

Diseño

Registro prospectivo de los ingresos de 6 años consecutivos. Análisis retrospectivo de la primera admisión de la cohorte de los supervivientes a UCI.

Ámbito

UCI polivalente de 10 camas en hospital general de segundo nivel con 540 camas.

Pacientes

1.521 pacientes con más de 12 horas de estancia, dados de alta vivos y con desenlace hospitalario conocido.

Intervenciones

Ninguna.

Principales variables de interés

Se registró el tipo de alta de la unidad, normal o no programada, y se exploró su relación con la mortalidad hospitalaria post-UCI, las tasas de readmisión y la estancia hospitalaria post-UCI.

Resultados

Hubo 165 altas no programadas (10,8%). La tasa de mortalidad fue del 11,6% (176 pacientes). Los factores relacionados con la mortalidad fueron la limitación del esfuerzo terapéutico (OR=14,02 4,6–42,6), las readmisiones (OR=3,46 1,76–6,78), las altas no programadas (OR=2,16 1,06–4,41), la puntuación de fallos orgánicos al alta de UCI (OR=1,16 1,01–1,32) y la edad (OR=1,03 1,01–1,05). Las readmisiones y las estancias post-UCI no diferían significativamente entre las altas no programadas y las normales (el 7,3 frente al 8,2%; p=0,68 y 16, 7±16,7 frente a 18,7±21,3 días, respectivamente; p=0,162).

Conclusiones

Las altas no programadas son frecuentes en nuestro medio y contribuyen significativamente a la mortalidad post-UCI, sin que parezcan afectar a otros resultados de la asistencia a pacientes críticos.

Palabras clave:

UCI

Altas no programadas

LET

Mortalidad hospitalaria post-UCI

Readmisión

SOFA

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