Increased risk of death and readmission after hospital discharge of critically ill patients in a developing country: a retrospective multicenter cohort study.
Intensive Care Med
; 44(7): 1090-1096, 2018 07.
Article
em En
| MEDLINE
| ID: mdl-30003303
ABSTRACT
PURPOSE:
To describe long-term mortality and hospital readmissions of patients admitted to Brazilian intensive care units (ICU).METHODS:
Retrospective cohort study of adult patients admitted to Brazilian hospitals affiliated to the Public Healthcare System from 10 state capitals. ICU patients were paired to non-ICU patients by frequency matching (ratio 12), according to postal code and admission semester. Hospitalization records were linked through deterministic linkage to national mortality data. Primary outcome was mortality up to 1 year. Other outcomes were mortality and readmissions at 30 and 90 days and 3 years. Multiple Cox regressions were used adjusting for age, sex, cancer diagnosis, type of hospital, and surgical status.RESULTS:
We included 324,594 patients (108,302 ICU and 216,292 non-ICU). ICU patients had increased hospital length of stay [9 (5-17) vs. 3 (1-6) days, p < 0.001] and mortality (18.5 vs. 3.6%, p < 0.001) versus non-ICU patients. One year after discharge, ICU patients were more frequently readmitted to hospital (25.4 vs. 17.4%, p < 0.001) and to ICU (31.4 vs. 7.3%, p < 0.001) than controls. Mortality up to 1 year was also higher for ICU patients (14.3 vs. 3.9%, p < 0.001). A significant interaction between surgical status and mortality was found, with adjusted hazard ratios (HRs) up to 1 year of 2.7 [95% confidence interval (CI) 2.5-2.9] for surgical patients, and 3.4 (95%CI 3.3-3.5) for medical patients. The risk for death and readmission diminished over time up to 3 years.CONCLUSIONS:
In a public healthcare system of a developing country, ICU patients have excessive long-term mortality and frequent readmissions. The ICU burden tended to reduce over time after hospital discharge.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Temas:
Aperfeicoar_gestao_SUS
/
Promover_ampliacao_atencao_especializada
Contexto em Saúde:
11_ODS3_cobertura_universal
Base de dados:
MEDLINE
Assunto principal:
Readmissão do Paciente
/
Estado Terminal
/
Países em Desenvolvimento
/
Unidades de Terapia Intensiva
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspecto:
Determinantes_sociais_saude
Limite:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do sul
/
Brasil
Idioma:
En
Revista:
Intensive Care Med
Ano de publicação:
2018
Tipo de documento:
Article