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Mortality after hospital discharge in ICU patients
Sylvia Brinkman1, Evert de Jonge, Ameen Abu-Hanna
1Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands. s.brinkman@amc.uva.nl
Objectives:
To assess the mortality risk of ICU patients after hospital discharge and compare it to mortality of the general Dutch population.
Design:
Cohort study of ICU admissions from a national ICU registry linked to administrative records from an insurance claims database.
Setting:
Eighty-one Dutch ICUs.
Patients:
ICU patients (n = 91,203) who were discharged alive from the hospital between January 1, 2007, and October 1, 2010.
Interventions:
None.
Measurements And Main Results:
The unadjusted observed survival was inspected by Kaplan-Meier curves. Mortality risk at 1, 2, and 3 years after hospital discharge was 12.5%, 19.3%, and 27.5%, respectively. The 3-year mortality after hospital discharge in ICU patients was higher than the weighted average of the gender and age-specific death risks of the general Dutch population (27.5% versus 8.2%). The 1-year mortality after hospital discharge was adjusted for case-mix differences by a set of determinants which showed a statistically significant influence on the outcome in a 10-fold cross validation. The elective and cardiac surgical patients have statistically significantly better mortality outcomes (adjusted hazard ratio, 0.73 and 0.28, respectively), whereas medical patients and patients admitted for cancer have statistically significantly worse mortality outcomes (adjusted hazard ratio, 1.41, 1.94, respectively) compared with other ICU patients. Urgent surgery patients and patients with a subarachnoid hemorrhage, trauma, acute renal failure, or severe community-acquired pneumonia did not differ statistically from the other ICU patients after adjustment for case-mix differences.
Conclusions:
In-hospital mortality underestimates the true mortality of ICU patients as the mortality in the first months after hospital discharge is substantial. Most ICU patients still have an increased mortality risk in the subsequent years after hospital discharge compared with the general Dutch population. The mortality after hospital discharge differs widely between ICU subgroups. Future studies should focus on the analysis of mortality after hospital discharge that is attributable to the former ICU admission.
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