Readmission to a surgical intensive care unit: incidence, outcome and risk factors

Axel Kaben, Fabiano Corrêa, Konrad Reinhart, Utz Settmacher, Jan Gummert, Rolf Kalff, Yasser Sakr, Axel Kaben, Fabiano Corrêa, Konrad Reinhart, Utz Settmacher, Jan Gummert, Rolf Kalff, Yasser Sakr

Abstract

Introduction: We investigated the incidence of, outcome from and possible risk factors for readmission to the surgical intensive care unit (ICU) at Friedrich Schiller University Hospital, Jena, Germany.

Methods: We conducted an analysis of prospectively collected data from all patients admitted to the postoperative ICU between September 2004 and July 2006.

Results: Of 3169 patients admitted to the ICU during the study period, 2852 were discharged to the hospital floor and these patients made up the study group (1828 male (64.1%), mean patient age 62 years). The readmission rate was 13.4% (n = 381): 314 (82.4%) were readmitted once, 39 (10.2%) were readmitted twice and 28 (7.3%) were readmitted more than twice. The first readmission to the ICU occurred within a median of seven days (range 5 to 14 days). Patients who were readmitted to the ICU had a higher simplified acute physiology II score (37 +/- 16 versus 33 +/- 16; p < 0.001) and sequential organ failure score (6 +/- 3 versus 5 +/- 3; p = 0.001) on initial admission to the ICU than those who were not readmitted. In-hospital mortality was significantly higher in patients readmitted to the ICU (17.1% versus 2.9%; p < 0.001) than in other patients. In a multivariate analysis, age (odds ratio (OR) = 1.13 per 10 years; 95% confidence interval (CI) = 1.03 to 1.24; p = 0.04), maximum sequential organ failure score (OR = 1.04 per point; 95% CI = 1.01 to 1.08; p = 0.04) and C-reactive protein levels on the day of discharge to the hospital floor (OR = 1.02; 95% CI = 1.01 to 1.04; p = 0.035) were independently associated with a higher risk of readmission to the ICU.

Conclusions: In this group of surgical ICU patients, readmission to the ICU was associated with a more than five-fold increase in hospital mortality. Older age, higher maximum sequential organ failure score and higher C-reactive protein levels on the day of discharge to the hospital floor were independently associated with a higher risk of readmission to the ICU.

Figures

Figure 1
Figure 1
Histogram representing time to first readmission to the intensive care unit (ICU).
Figure 2
Figure 2
Time course of sequential organ failure assessment (SOFA) score during the first two weeks in the intensive care unit (ICU) in patients who were readmitted to the ICU. Closed circles = scores during the initial stay; closed triangle = score during the first readmission. *p < 0.05 compared with initial stay (Mann Whitney U test); †p < 0.05 over time (Friedmann test).

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