Long-stay patients in Australian and New Zealand intensive care units: demographics and outcomes.
OBJECTIVE
There is no consensus definition on what constitutes a long stay in the intensive care unit, and little published information on the demographic characteristics, resource usage or outcomes of long-stay patients. We used data from the Australian and New Zealand Intensive Care Society Adult Patient Database to identify patients who had spent > 21 days in the ICU. We examined their resource usage, hospital type, diagnoses and outcomes, and trends in these characteristics over 5 years (2000-2004).


RESULTS
6,565 patients (2.3% of all ICU patients) had one or more admissions > 21 days and accounted for 23% of total ICU bed-hour usage. Long-stay patients had a mean (SD) age of 60.3 (15.3) years and an APACHE III-J risk of death of 32.7% (21.3%). Metropolitan and tertiary hospitals had the highest proportions of long-stay patients. The three diagnoses most strongly associated with long ICU stay were neuromuscular disease (odds ratio [OR], 13.3; 95% CI, 10.2-17.4; P < 0.001), burns (OR, 6.0; 95% CI, 4.9-7.3; P < 0.001) and cervical spine injury (OR, 5.1; 95% CI, 3.4-7.5; P < 0.001), while the most common diagnosis was pneumonia (12.7% of total). During the period 2000- 2004, there was no significant change in the proportion, age, resource usage or outcomes of these patients. Overall observed mortality was 28% (predicted, 32.7%; 95% CI, 31.4%-34.5%). Of those aged >or= 80 years, 37% were discharged home, and 39% died.


CONCLUSIONS
Patients who spend > 21 days in the ICU use significant resources but appear to have worthwhile outcomes in all age brackets.
Intensive Care Unit, Monash Medical Centre, Melbourne, VIC. Tim.Crozier@southernhealth.org.au
Tim M E
TM
Crozier
David V
DV
Pilcher
Michael J
MJ
Bailey
Carol
C
George
Graeme K
GK
Hart
D018806:APACHE; D000328:Adult; D000368:Aged; D001315:Australia; D005260:Female; D019538:Health Care Surveys; D006304:Health Status; D017721:Hospital Costs; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000628:therapy; D009520:New Zealand; D016017:Odds Ratio; D011014:Pneumonia / Q000628:therapy; D012140:Respiratory Tract Diseases / Q000628:therapy; D014600:Utilization Review