Unplanned discharges from a surgical intensive care unit: readmissions and mortality.
OBJECTIVE
There is great patient turnover every day on surgical intensive care units (SICUs). Surgical intensive care unit beds are provided for major elective surgery. Emergency admissions trigger unplanned discharges. Those patients are at risk for a worse outcome.


METHODS
We retrospectively analyzed 2558 patients discharged from a 20-bed SICU within 1 year. They were followed up whether discharged electively or not. Patients readmitted to the SICU were stratified according to reason for readmission.


RESULTS
Readmission rate to the SICU was 8.3% (139/1675) in elective discharges, and 25.1% (110/439) in unplanned discharges (P < .001); 50% (125/249) of all readmissions were for surgical complications. Hospital mortality was 2.28% (50/2,197) in patients not readmitted to the SICU and 13.3% (33/249) for those readmitted (P < .001). The mortality rate increased by 4% in readmissions for each year of age (P < .05, OR for death 1.04 for each year of age, 95% CI 1.010-1.071). Respiratory failure as a reason for readmission implied a 44% risk of death (P < .001, OR 11.85, 95% CI 5.11-27.45).


CONCLUSIONS
Earlier-than-planned discharge from a SICU leads to a substantially higher readmission rate. Readmission correlates with an elevated risk of death. Most readmissions in a surgical clinic are due to surgical complications. Readmission for respiratory failure accounts for most of the mortality.
Utzolino
Stefan
S
Department of General and Visceral Surgery, University of Freiburg, Freiburg, 79106, Germany. stefan.utzolino@uniklinik-freiburg.de
Kaffarnik
Magnus
M
Keck
Tobias
T
Berlet
Meike
M
Hopt
Ulrich Theodor
UT
D003422:Critical Care; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000401:mortality; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome