Hospital discharge to care facility: a patient-centered outcome for the evaluation of intensive care for octogenarians.
BACKGROUND
Hospital survival and length of stay are commonly used for the evaluation of intensive care outcome for the young and octogenarian patients (>/= 80 years old).


OBJECTIVE
Hospital discharge to a care facility should be considered for more accurate evaluation of intensive care outcome, especially for octogenarian patients.


METHODS
An observational descriptive study.


METHODS
A total of 6,154 consecutive hospital admissions requiring intensive care over 4 years.


METHODS
Demographics, preadmission comorbidities, severity of illness, acute hospital diagnosis categories, charges and destination after discharge, and postdischarge survival for up to 42 months.


RESULTS
Octogenarians represented 15% of intensive care admissions (900 admissions). The interventions performed in the ICU, the severity of illness measured by sequential organ failure assessment (SOFA), and hospital length of stay were similar for octogenarian and younger patients. Octogenarians had higher hospital mortality (10% vs 6%, p < 0.01) and discharge to care facility (35% vs 18%, p < 0.01) than younger patients. The average hospital charge per octogenarian hospital survivor discharged to home was $128,000, compared to $100,000 for a younger hospital survivor. At follow-up, octogenarian hospital survivors who were discharged to a care facility had higher mortality than hospital survivors discharged to home (31% vs 17%, p < 0.01). On multiple logistic regression, older age, female gender, preadmission comorbidities, type of admission, SOFA score >/= 4, mechanical ventilation >/= 96 h, requirement for tracheotomy, and hospital diagnosis categories were independent factors for discharge of hospital survivors to a care facility.


CONCLUSIONS
Hospital survival and length of stay did not accurately measure intensive care outcome for octogenarians. Care dependency among octogenarians who survived intensive care was prevalent and decreased their long-term survival. Care dependency and functional disability among hospital survivors should be considered for more accurate evaluation of intensive care outcome in that age group.
Rady
Mohamed Y
MY
Mayo Clinic Hospital, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
Johnson
Daniel J
DJ
D000328:Adult; D000359:Aftercare / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003422:Critical Care / Q000592:standards*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D018802:Patient-Centered Care / Q000592:standards*; D016019:Survival Analysis