Survival of critically ill surgical patients discharged to extended care facilities

• Published in: Journal of the American College of Surgeons Vol. 189; no. 5; pp. 437 - 441
• Main Authors: Cook, Charles H, Martin, Larry C, Howard, Barbara, Flancbaum, Louis J
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.1999; Elsevier Science; American College of Surgeons
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; APACHE; Biological and medical sciences; Chi-Square Distribution; Critical Care - statistics & numerical data; Critical Illness - mortality; Emergency and intensive postoperative care (general aspects). Pathophysiology of surgery; Female; Follow-Up Studies; Hospital Mortality; Humans; Intensive care medicine; Length of Stay - statistics & numerical data; Longitudinal Studies; Male; Medical sciences; Middle Aged; Miscellaneous; Patient Discharge; Prospective Studies; Risk Factors; Skilled Nursing Facilities - statistics & numerical data; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Procedures, Operative - mortality; Surgical Procedures, Operative - statistics & numerical data; Survival Rate; Human; Follow up study; Surgery; Transfer; Evolution; Patient; Duration; Hospitalization; Epidemiology; Survival; Intensive care unit
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/S1072-7515(99)00191-X

Background: Rates of discharge of surgical ICU (SICU) patients to extended care facilities (ECF) increase as SICU length of stay (LOS) increases. Increased SICU LOS and APACHE II scores have been related to increased hospital mortality. This study evaluated factors influencing ECF survival after SICU patient discharge. Study Design: We did a longitudinal followup study of patients admitted to our tertiary care SICU during a 2-year period who were eventually discharged to ECF. Demographic data, SICU admission APACHE II score, and LOS data were obtained prospectively. Patient followup was obtained 2 years after discharge by telephone interviews with patients themselves or next of kin to ascertain current status or date of demise. Results: Of 1,799 SICU patients admitted during the study period, 160 patients (9%) were discharged to an ECF. Telephone followup was obtained from 150 patients (94%). Mean length of followup was 21 months after hospital discharge (range 7 to 34 months), mean patient age 64 years (range 16 to 96 years), mean SICU admission APACHE II score 13 (range 2 to 29), and mean SICU LOS 11 days (range 1 to 146 days). At followup, 45% of patients had died, 37% had been discharged home, and 18% still resided in an ECF or hospital. Elderly patients (above age 65) had significantly worse 1-year (p < 0.001) and 2-year (p < 0.001) ECF survival than nonelderly patients. Patients admitted to the SICU after otolaryngologic procedures also had significantly worse 1- and 2-year ECF survival than all other patients. Severity of illness as estimated by admission APACHE II scores or SICU LOS does not seem to influence survival. Conclusions: Outcomes of ECF discharge after SICU admission is poor, with nearly 50% 2-year mortality. ECF mortality seems significantly higher for the elderly, with patients undergoing otolaryngologic procedures being at highest risk. Severity of illness at the time of SICU admission and SICU LOS does not seem to influence ECF outcomes.