Readmission to the intensive care unit: an indicator that reflects the potential risks of morbidity and mortality of surgical patients in the intensive care unit

Khee-Siang Chan, Che-Kim Tan, Chiu-Shu Fang, Chi-Lun Tsai, Ching-Cheng Hou, Kuo-Chen Cheng, Meng-Chih Lee
Surgery Today 2009, 39 (4): 295-9

PURPOSE: To investigate the characteristics and outcomes of surgical patients who were readmitted to the intensive care unit (ICU).

METHODS: The data were collected for all readmissions to the surgical ICUs in a tertiary hospital in the year 2003.

RESULTS: Of all the 945 ICU discharges, 110 patients (11.6%) were readmitted. They had a longer initial ICU stay (8.05 +/- 7.17 vs 5.22 +/- 4.95, P < 0.001) and were older and in a more severe condition than those not readmitted, but with a longer hospital stay and higher mortality rate (40% vs 3.6%, P < 0.001). A total of 26.4% of the readmission patients had an early readmission (<48 h), with a lower mortality rate than those with a late readmission (24.1% vs 45.7%, P = 0.049). A total of 46.4% of the patients were readmitted with the same diagnosis while the rest were readmitted with a new complication. Respiratory disease was the most common diagnosis for patients readmitted with a new complication (66.1%). The nonsurvivors had a significantly higher second Acute Physiology and Chronic Health Evaluation (APACHE II) score (22.1 +/- 8.8 vs.14.6 +/- 7.4, P < 0.001) and second Therapeutic Intervention Scoring System (TISS) score (30.1 +/- 8.7 vs 24.7 +/- 7.6, P = 0.001) and a longer stay in the first ICU admission (10.4 +/- 9 days vs 6.4 +/- 5 days, P = 0.010). A multivariate analysis showed that the first ICU length of stay and the APACHE II score at the time of readmission were the two risk factors for mortality.

CONCLUSION: The mortality of surgical patients with ICU readmission was high with respiratory complications being the most important issue.

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