title: Early and late unplanned rehospitalizations for survivors of critical illness*.
abstract: OBJECTIVE
  Preventing rehospitalizations for patients with serious chronic illnesses is a focus of national quality initiatives. Although 8 million people are admitted yearly to an ICU, the frequency of rehospitalizations (readmissions to the hospital after discharge) is unknown. We sought to determine the frequency of rehospitalization after an ICU stay, outcomes for rehospitalized patients, and factors associated with rehospitalization.
  
  
  METHODS
  Retrospective cohort study using the New York Statewide Planning and Research Cooperative System, an administrative database of all hospital discharges in New York State.
  
  
  METHODS
  ICUs in New York State.
  
  
  METHODS
  ICU patients who survived to hospital discharge in 2008-2010.
  
  
  METHODS
  None.
  
  
  RESULTS
  Primary outcome was the cumulative incidence of first early rehospitalization (within 30 days of discharge), and secondary outcome was the cumulative incidence of late rehospitalization (between 31 and 180 d). Factors associated with rehospitalization within both time periods were identified using competing risk regression models. Of 492,653 ICU patients, 79,960 had a first early rehospitalization (cumulative incidence, 16.2%) and an additional 73,250 late rehospitalizations (cumulative incidence, 18.9%). Over one quarter of all rehospitalizations (28.6% for early; 26.7% for late) involved ICU admission. Overall hospital mortality for rehospitalized patients was 7.6% for early and 4.6% for late rehospitalizations. Longer index hospitalization (adjusted hazard ratio, 1.61; 95% CI, 1.57-1.66 for 7-13 d vs < 3 d), discharge to a skilled nursing facility versus home (adjusted hazard ratio, 1.54; 95% CI, 1.51-1.58), and having metastatic cancer (adjusted hazard ratio, 1.46; 95% CI, 1.41-1.51) were associated with the greatest hazard of early rehospitalization.
  
  
  CONCLUSIONS
  Approximately 16% of ICU survivors were rehospitalized within 30 days of hospital discharge; rehospitalized patients had high rates of ICU admission and hospital mortality. Few characteristics were strongly associated with rehospitalization, suggesting that identifying high-risk individuals for intervention may require additional predictors beyond what is available in administrative databases.
authors.affiliation: 1Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY. 2Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY. 3Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY. 4Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. 5Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 6Department of Anesthesiology, University of Toronto, Toronto, ON, Canada.
authors.forename: May
authors.initials: M
authors.lastname: Hua
authors.forename: Michelle Ng
authors.initials: MN
authors.lastname: Gong
authors.forename: Joanne
authors.initials: J
authors.lastname: Brady
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors