Institution-free days after critical illness: A multicenter retrospective study

Area of Science:

• Critical Care Medicine
• Health Outcomes Research

Background:

• Patient-centered outcomes beyond mortality are increasingly important in critical care research.
• Institution-free days (IFD) represent a significant outcome measure in this field.

Purpose of the Study:

• To analyze the impact of different definitions of IFD on study results.
• To identify determinants of IFD and assess their association with various definitions.

Main Methods:

• IFD was calculated using three distinct definitions, differing in handling of death and after-hospital deaths.
• Data from 25,371 adult ICU admissions in North Brisbane, Australia, were analyzed.
• Six pre-specified variables were assessed as potential determinants of IFD.

Main Results:

• The distribution of IFD was bimodal, with a peak at 0 days and a variable peak based on definition.
• Mean IFD ranged from 253 to 295 days, depending on the definition employed.
• Multivariable regression revealed significant associations between the six variables and IFD, with varying effect magnitudes across definitions.

Conclusions:

• IFD is a straightforward, measurable patient-centered outcome.
• The definition used significantly influences IFD results and interpretation.
• Patient involvement is recommended to establish the optimal definition and clinical application of IFD.