title: Mortality after hospital discharge in ICU patients.
abstract: OBJECTIVE
  To assess the mortality risk of ICU patients after hospital discharge and compare it to mortality of the general Dutch population.
  
  
  METHODS
  Cohort study of ICU admissions from a national ICU registry linked to administrative records from an insurance claims database.
  
  
  METHODS
  Eighty-one Dutch ICUs.
  
  
  METHODS
  ICU patients (n = 91,203) who were discharged alive from the hospital between January 1, 2007, and October 1, 2010.
  
  
  METHODS
  None.
  
  
  RESULTS
  The unadjusted observed survival was inspected by Kaplan-Meier curves. Mortality risk at 1, 2, and 3 years after hospital discharge was 12.5%, 19.3%, and 27.5%, respectively. The 3-year mortality after hospital discharge in ICU patients was higher than the weighted average of the gender and age-specific death risks of the general Dutch population (27.5% versus 8.2%). The 1-year mortality after hospital discharge was adjusted for case-mix differences by a set of determinants which showed a statistically significant influence on the outcome in a 10-fold cross validation. The elective and cardiac surgical patients have statistically significantly better mortality outcomes (adjusted hazard ratio, 0.73 and 0.28, respectively), whereas medical patients and patients admitted for cancer have statistically significantly worse mortality outcomes (adjusted hazard ratio, 1.41, 1.94, respectively) compared with other ICU patients. Urgent surgery patients and patients with a subarachnoid hemorrhage, trauma, acute renal failure, or severe community-acquired pneumonia did not differ statistically from the other ICU patients after adjustment for case-mix differences.
  
  
  CONCLUSIONS
  In-hospital mortality underestimates the true mortality of ICU patients as the mortality in the first months after hospital discharge is substantial. Most ICU patients still have an increased mortality risk in the subsequent years after hospital discharge compared with the general Dutch population. The mortality after hospital discharge differs widely between ICU subgroups. Future studies should focus on the analysis of mortality after hospital discharge that is attributable to the former ICU admission.
authors.affiliation: Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands. s.brinkman@amc.uva.nl
authors.forename: Sylvia
authors.initials: S
authors.lastname: Brinkman
authors.forename: Evert
authors.initials: E
authors.lastname: de Jonge
authors.forename: Ameen
authors.initials: A
authors.lastname: Abu-Hanna
authors.forename: M Sesmu
authors.initials: MS
authors.lastname: Arbous
authors.forename: Dylan W
authors.initials: DW
authors.lastname: de Lange
authors.forename: Nicolette F
authors.initials: NF
authors.lastname: de Keizer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010351:Patient Discharge / Q000706:statistics & numerical data; D012016:Reference Values; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis