Unplanned discharges from a surgical intensive care unit: readmissions and mortality.

PURPOSE There is great patient turnover every day on surgical intensive care units (SICUs). Surgical intensive care unit beds are provided for major elective surgery. Emergency admissions trigger unplanned discharges. Those patients are at risk for a worse outcome. MATERIALS AND METHODS We retrospectively analyzed 2558 patients discharged from a 20-bed SICU within 1 year. They were followed up whether discharged electively or not. Patients readmitted to the SICU were stratified according to reason for readmission. RESULTS Readmission rate to the SICU was 8.3% (139/1675) in elective discharges, and 25.1% (110/439) in unplanned discharges (P < .001); 50% (125/249) of all readmissions were for surgical complications. Hospital mortality was 2.28% (50/2,197) in patients not readmitted to the SICU and 13.3% (33/249) for those readmitted (P < .001). The mortality rate increased by 4% in readmissions for each year of age (P < .05, OR for death 1.04 for each year of age, 95% CI 1.010-1.071). Respiratory failure as a reason for readmission implied a 44% risk of death (P < .001, OR 11.85, 95% CI 5.11-27.45). CONCLUSIONS Earlier-than-planned discharge from a SICU leads to a substantially higher readmission rate. Readmission correlates with an elevated risk of death. Most readmissions in a surgical clinic are due to surgical complications. Readmission for respiratory failure accounts for most of the mortality.

[1]  C-reactive protein concentration as a predictor of intensive care unit readmission: a nested case-control study. , 2006, Journal of critical care.

[2]  N Snow,et al.  Readmission of patients to the surgical intensive care unit: Patient profiles and possibilities for prevention , 1985, Critical care medicine.

[3]  Corinne Alberti,et al.  Determinants of postintensive care unit mortality: A prospective multicenter study , 2003, Critical care medicine.

[4]  John D Santamaria,et al.  After‐hours discharges from intensive care are associated with increased mortality , 2006, The Medical journal of Australia.

[5]  A. Gascoigne,et al.  TISS and mortality after discharge from intensive care , 1999, Intensive Care Medicine.

[6]  S. Stawicki,et al.  The surgeon and the intensivist: reaching consensus in intensive care triage. , 2007, Journal of surgical education.

[7]  [Cost of intensive care in a German hospital: cost-unit accounting based on the InEK matrix]. , 2008, Der Anaesthesist.

[8]  C. Franklin,et al.  Discharge decision‐making in a medical ICU: Characteristics of unexpected readmissions , 1983, Critical care medicine.

[9]  M. Shabot,et al.  Readmission to surgical intensive care increases severity-adjusted patient mortality. , 2006, The Journal of trauma.

[10]  P. McQuillan,et al.  Waiting for the break of dawn? The effects of discharge time, discharge TISS scores and discharge facility on hospital mortality after intensive care. , 2002, Intensive care medicine.

[11]  A. Rosenberg,et al.  Patients readmitted to ICUs* : a systematic review of risk factors and outcomes. , 2000, Chest.

[12]  C. Wallis,et al.  Why do patients die on general wards after discharge from intensive care units? , 1997, Anaesthesia.

[13]  F. Priestap,et al.  Impact of intensive care unit discharge time on patient outcome , 2006, Critical care medicine.

[14]  P. McQuillan,et al.  Waiting for the break of dawn? , 2002, Intensive Care Medicine.

[15]  F. Kanat,et al.  RISK FACTORS FOR POSTOPERATIVE PULMONARY COMPLICATIONS IN UPPER ABDOMINAL SURGERY , 2007, ANZ journal of surgery.

[16]  R. McIntyre,et al.  Less is more: improved outcomes in surgical patients with conservative fluid administration and central venous catheter monitoring. , 2009, Journal of the American College of Surgeons.

[17]  R. Hayward,et al.  Who bounces back? Physiologic and other predictors of intensive care unit readmission , 2001, Critical care medicine.

[18]  A. Kari,et al.  Ruokonen The effects of ICU admission and discharge times on mortality in Finland , 2003 .

[19]  C. Waydhas.  Bedeutung der Intermediate Care Station , 2005 .

[20]  M. Hashizume,et al.  Investigation of the Cause of Readmission to the Intensive Care Unit for Patients with Lung Edema or Atelectasis , 2008, Yonsei medical journal.

[21]  W. Baigelman,et al.  Patient readmission to critical care units during the same hospitalization at a community teaching hospital , 2005, Intensive Care Medicine.

[22]  C. Durbin,et al.  A case‐control study of patients readmitted to the intensive care unit , 1993, Critical care medicine.

[23]  R. Moreno,et al.  Mortality after discharge from intensive care: the impact of organ system failure and nursing workload use at discharge , 2001, Intensive Care Medicine.

[24]  J. Brooks-Brunn.  Predictors of postoperative pulmonary complications following abdominal surgery. , 1997, Chest.

[25]  A. Morabito,et al.  Determinants of post-intensive care mortality in high-level treated critically ill patients , 2003, Intensive Care Medicine.

[26]  F. Pott,et al.  Effects of Intravenous Fluid Restriction on Postoperative Complications: Comparison of Two Perioperative Fluid Regimens: A Randomized Assessor-Blinded Multicenter Trial , 2003, Annals of surgery.

[27]  S. Ridley,et al.  Intermediate outcome of medical patients after intensive care , 2001, Anaesthesia.

[28]  J. Légaré,et al.  ICU readmission after cardiac surgery. , 2003, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[29]  W J Sibbald,et al.  Patients readmitted to the intensive care unit during the same hospitalization: clinical features and outcomes. , 1998, Critical care medicine.

[30]  S. Koh,et al.  Discharge decision-making by intensivists on readmission to the intensive care unit. , 2004, Yonsei medical journal.

[31]  M. Shabot,et al.  Analysis of Causes and Prevention of Early Readmission to Surgical Intensive Care , 2003, The American surgeon.

[32]  C. Goldfrad,et al.  Consequences of discharges from intensive care at night , 2000, The Lancet.

[33]  G. Duke,et al.  Night-shift Discharge from Intensive Care Unit Increases the Mortality-risk of ICU Survivors , 2004, Anaesthesia and intensive care.

[34]  M. Bauer,et al.  Kosten der intensivmedizinischen Versorgung in einem deutschen Krankenhaus , 2008, Der Anaesthesist.

[35]  B. Cuthbertson,et al.  Predicting death and readmission after intensive care discharge. , 2008, British journal of anaesthesia.

[36]  Laura Caramanica.  Discharge Decision-Making in a Medical ICU: Characteristics of Unexpected Readmissions , 1984 .

[37]  A J Rotondi,et al.  Are readmissions to the intensive care unit a useful measure of hospital performance? , 1999, Medical care.