title: Epidemiology and outcomes of in-hospital cardiopulmonary resuscitation in the United States, 2000-2009.
abstract: OBJECTIVE
  To examine temporal trends in the epidemiology and outcomes of in-hospital cardiopulmonary resuscitation (CPR) recipients at a population level.
  
  
  METHODS
  Retrospective analysis of temporal trends in CPR incidence, survival to discharge, discharge disposition, hospital length of stay, and cost of hospitalization for CPR recipients (age ≥ 18 years) captured in the Nationwide Inpatient Sample (2000-2009) in the United States.
  
  
  RESULTS
  Between years 2000 and 2009, CPR incidence increased by 33.7%, from 1 case per 453 to 1 case per 339 hospitalized patients (annual percentage increase: 4.3%, 95% CI: 3.4-5.2%, p<0.001). Compared to CPR recipients in years 2000-2001, those in 2008-2009 were more often younger (age<65 years: 33.4% vs. 40.0%), non-white (29.3% vs. 36.4%), and higher comorbidity scores (score ≥ 4: 22.2% vs. 27.1%) (all p<0.001). Rates of neurologic compromise, mechanical ventilator, and feeding tube use increased by 37.7, 28.2, and 58.5%, respectively (all p<0.001). Adjusted rate of survival to discharge increased by 41.3% (20.6-29.1%, p<0.001). Compared to survivors in 2000, those discharged in 2009 were more often discharged to hospice (0.4% vs. 7.1%, p<0.001); a 35% decrease in discharge to home was noted (36.4% vs. 23.8%, p<0.001). Mean cost of hospitalization per day increased for both survivors ($2742-$3462, p=0.006) and decedents ($3159-$4212, p<0.001).
  
  
  CONCLUSIONS
  The rate of in-hospital CPR in the U.S. increased, and CPR recipients have become younger and sicker over time. Survival to discharge has improved by 41.3%. Functional outcomes after in-hospital CPR appear to have worsened, with considerable clinical and economic implications.
authors.affiliation: Stanford University, Department of General Surgery, Palo Alto, CA, USA.
authors.forename: Hadiza S
authors.initials: HS
authors.lastname: Kazaure
authors.forename: Sanziana A
authors.initials: SA
authors.lastname: Roman
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: CPR; Cardiopulmonary resuscitation; HCUP NIS; Population outcomes; Survival; Temporal trends