Mortality and readmission among ventilator-dependent patients after successful weaned discharge from a respiratory care ward.
OBJECTIVE
Patients on prolonged mechanical ventilation in Taiwan are stepped down to a respiratory care ward (RCW) for further respiratory care. Only a few patients in the RCW can ultimately be weaned and discharged. In this study, we tried to determine factors that predict mortality and readmission of these patients in the post-discharge period.


METHODS
Between May 1, 2004 and October 31, 2006, clinical data were retrospectively analyzed for eligible patients in a RCW. Patients who were successfully weaned from mechanical ventilation were enrolled in this study.


RESULTS
A total of 243 patients were eligible for evaluation, and 67 patients were successfully weaned and discharged. By Kaplan-Meier curve, 36 (67.1%) patients were readmitted within 3 months after discharge, and among these, 23 (63.9%) had mechanical ventilation reinstituted at the time of first readmission. The most common cause of readmission was airway infection (80.5%). Overall mortality and readmission rates at 1 year after weaned discharge were 32.9% and 88.2%, respectively. By multivariate analysis, patients with neurologic causes of ventilator dependency were less likely to be readmitted (hazard ratio = 0.36; p =0.034), and neoplastic diseases (hazard ratio = 4.66; p =0.031) were independently associated with mortality.


CONCLUSIONS
Underlying comorbidities and causes of ventilator dependency are important predictors of mortality and readmission among patients after weaned discharge from a RCW.
Hui
Chun
C
Department of Chest Medicine, Cheng-Ching General Hospital, Taichung Veterans General Hospital, Taichung, Taiwan. ph3124wr@yahoo.com.tw
Lin
Ming-Chih
MC
Liu
Tu-Chen
TC
Wu
Ren-Guang
RG
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012124:Respiratory Care Units; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000706:statistics & numerical data*