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Early and Late Unplanned Rehospitalizations for Survivors of Critical Illness*

Hua, May MD1; Gong, Michelle Ng MD, MSc2,3; Brady, Joanne PhD1,4; Wunsch, Hannah MD, MSc1,4,5,6

doi: 10.1097/CCM.0000000000000717
Clinical Investigations
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Objectives: Preventing rehospitalizations for patients with serious chronic illnesses is a focus of national quality initiatives. Although 8 million people are admitted yearly to an ICU, the frequency of rehospitalizations (readmissions to the hospital after discharge) is unknown. We sought to determine the frequency of rehospitalization after an ICU stay, outcomes for rehospitalized patients, and factors associated with rehospitalization.

Design: Retrospective cohort study using the New York Statewide Planning and Research Cooperative System, an administrative database of all hospital discharges in New York State.

Setting: ICUs in New York State.

Patients: ICU patients who survived to hospital discharge in 2008–2010.

Interventions: None.

Measurements and Main Results: Primary outcome was the cumulative incidence of first early rehospitalization (within 30 days of discharge), and secondary outcome was the cumulative incidence of late rehospitalization (between 31 and 180 d). Factors associated with rehospitalization within both time periods were identified using competing risk regression models. Of 492,653 ICU patients, 79,960 had a first early rehospitalization (cumulative incidence, 16.2%) and an additional 73,250 late rehospitalizations (cumulative incidence, 18.9%). Over one quarter of all rehospitalizations (28.6% for early; 26.7% for late) involved ICU admission. Overall hospital mortality for rehospitalized patients was 7.6% for early and 4.6% for late rehospitalizations. Longer index hospitalization (adjusted hazard ratio, 1.61; 95% CI, 1.57–1.66 for 7–13 d vs < 3 d), discharge to a skilled nursing facility versus home (adjusted hazard ratio, 1.54; 95% CI, 1.51–1.58), and having metastatic cancer (adjusted hazard ratio, 1.46; 95% CI, 1.41–1.51) were associated with the greatest hazard of early rehospitalization.

Conclusions: Approximately 16% of ICU survivors were rehospitalized within 30 days of hospital discharge; rehospitalized patients had high rates of ICU admission and hospital mortality. Few characteristics were strongly associated with rehospitalization, suggesting that identifying high-risk individuals for intervention may require additional predictors beyond what is available in administrative databases.

Supplemental Digital Content is available in the text.

1Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY.

2Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY.

3Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY.

4Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY.

5Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.

6Department of Anesthesiology, University of Toronto, Toronto, ON, Canada.

* See also p. 504.

Dr. Hua helped conceive and design the study, acquire the data, conduct the study, analyze and interpret the data, and draft and critically revise the article. Dr. Gong helped conduct the study, interpret the data, and critically revise the article. Dr. Brady helped analyze and interpret the data and critically revise the article. Dr. Wunsch helped conceive and design the study, conduct the study, analyze and interpret the data, and draft and critically revise the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Hua is supported by a Mentored-Training Research Grant from the Foundation for Anesthesia Education and Research. Her institution received grant support from the Foundation for Anesthesia Education and Research. Dr. Gong is supported by the National Heart, Lung and Blood Institute (NIHLBI), National Institutes of Health through grant numbers U01 HL108712, U01 HL122998, and CMS 330964. Her institution received grant support from the NHLBI. Dr. Brady was supported, in part, by the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention (Grant 1 R49 CE002096), the National Institute on Drug Abuse (DA029670), and the National Institutes of Health. Dr. Wunsch is supported by the National Institute on Aging (Award Number K08AG038477), the National Center for Research Resources, the National Center for Advancing Translational Sciences, and the National Institutes of Health (grant number UL1 RR024156).

For information regarding this article, E-mail: mh2633@cumc.columbia.edu

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