title: Healthcare utilization in medical intensive care unit survivors with alcohol withdrawal.
abstract: BACKGROUND
  Rehospitalization is an important and costly outcome that occurs commonly in several diseases encountered in the medical intensive care unit (ICU). Although alcohol use disorders are present in 40% of ICU survivors and alcohol withdrawal is the most common alcohol-related reason for admission to an ICU, rates and predictors of rehospitalization have not been previously reported in this population.
  
  
  METHODS
  We conducted a retrospective cohort study of medical ICU survivors with a primary or secondary discharge diagnosis of alcohol withdrawal using 2 administrative databases. The primary outcome was time to rehospitalization or death. Secondary outcomes included time to first emergency department or urgent care clinic visit in the subset of ICU survivors who were not rehospitalized. Cox proportional hazard models were adjusted for age, gender, race, homelessness, smoking, and payer source.
  
  
  RESULTS
  Of 1,178 patients discharged from the medical ICU over the study period, 468 (40%) were readmitted to the hospital and 54 (4%) died within 1 year. Schizophrenia (hazard ratio 2.23, 95% CI 1.57, 3.34, p < 0.001), anxiety disorder (hazard ratio 2.04, 95% CI 1.30, 3.32, p < 0.01), depression (hazard ratio 1.62, 95% CI 1.05, 2.40, p = 0.03), and Deyo comorbidity score ≥3 (hazard ratio 1.43, 95% CI 1.09, 1.89, p = 0.01) were significant predictors of time to death or first rehospitalization. Bipolar disorder was associated with time to first emergency department or urgent care clinic visit (hazard ratio 2.03, 95% CI 1.24, 3.62, p < 0.01) in the 656 patients who were alive and not rehospitalized within 1 year.
  
  
  CONCLUSIONS
  The presence of a psychiatric comorbidity is a significant predictor of multiple measures of unplanned healthcare utilization in medical ICU survivors with a primary or secondary discharge diagnosis of alcohol withdrawal. This finding highlights the potential importance of targeting longitudinal multidisciplinary care to patients with a dual diagnosis.
authors: Division of Pulmonary Sciences and Critical Care Medicine , Department of Medicine, University of Colorado Denver, Aurora, Colorado.
authors: Brendan J
authors: BJ
authors: Clark
authors: Angela
authors: A
authors: Keniston
authors: Ivor S
authors: IS
authors: Douglas
authors: Thomas
authors: T
authors: Beresford
authors: Madison
authors: M
authors: Macht
authors: Andre
authors: A
authors: Williams
authors: Jacqueline
authors: J
authors: Jones
authors: Ellen L
authors: EL
authors: Burnham
authors: Marc
authors: M
authors: Moss
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010359:Patient Readmission / Q000639:trends; D012189:Retrospective Studies; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D017741:Survivors
keywords: Alcohol Use Disorder; Alcohol Withdrawal; Dual Diagnosis; Intensive Care Unit; Rehospitalization
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