Long-term admission to the intensive care unit: a cost-benefit analysis.
OBJECTIVE
To assess outcomes in long-term ICU patients, with follow-ups carried out at one year post discharge, in order to calculate the costs incurred by the hospital in relation to the benefits gained.


METHODS
Of 3639 patients consecutively admitted over the course of three years to ICU, 235 (6.5%) were assessed for the purposes of the study, having spent a period exceeding 20 days in intensive care.


METHODS
The survey tool used was the Spanish Minimum Data Set (MDS). The length of ICU stay and hospital stay following discharge from ICU were calculated, and one year post discharge the patient/next of kin was contacted in order to carry out a follow-up survey on survival and functional status (according to GOS-E scale).


RESULTS
The 235 study patients had a mean stay of 37 days, occupied 34% of ICU beds available and consumed 29% of the ICU's economic resources ($14,400,175). Their stay on hospital wards was (mean) 33 days. Mortality in ICU and on hospital wards was 40% higher amongst older patients, and those with a higher APACHE II and Charlson index score. Mortality rates were three times higher among neurosurgical patients: mortality at follow-up was 25%, and only 21% recovered an acceptable functional status.


CONCLUSIONS
Mortality rates in long-term ICU patients are high, both during their hospital stay and in the first year post discharge. Surviving patients do not exhibit a good level of recovery, and consume a large proportion of economic resources.
Intensive Care Medicine Department, Queen Elizabeth Hospital, London, United Kingdom. Electronic address: sancho.rodvil@hotmail.com.
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Rodríguez Villar
Madrid Care Centre for the Disabled, Madrid, Spain.
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Barrientos Yuste
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics*; D013030:Spain; D062606:Tertiary Care Centers / Q000191:economics*; D016896:Treatment Outcome
Cost; Costes; Cuidados intensivos; Estado funcional después del alta; Functional status post discharge; Intensive care; Long-stay patients; Mortalidad; Mortality; pacientes de larga duración