title: Relationship Between ICU Length of Stay and Long-Term Mortality for Elderly ICU Survivors.
abstract: OBJECTIVE
  To evaluate the association between length of ICU stay and 1-year mortality for elderly patients who survived to hospital discharge in the United States.
  
  
  METHODS
  Retrospective cohort study of a random sample of Medicare beneficiaries who survived to hospital discharge, with 1- and 3-year follow-up, stratified by the number of days of intensive care and with additional stratification based on receipt of mechanical ventilation.
  
  
  METHODS
  None.
  
  
  METHODS
  The cohort included 34,696 Medicare beneficiaries older than 65 years who received intensive care and survived to hospital discharge in 2005.
  
  
  RESULTS
  Among 34,696 patients who survived to hospital discharge, the mean ICU length of stay was 3.4 days (± 4.5 d). Patients (88.9%) were in the ICU for 1-6 days, representing 58.6% of ICU bed-days. Patients (1.3%) were in the ICU for 21 or more days, but these patients used 11.6% of bed-days. The percentage of mechanically ventilated patients increased with increasing length of stay (6.3% for 1-6 d in the ICU and 71.3% for ≥ 21 d). One-year mortality was 26.6%, ranging from 19.4% for patients in the ICU for 1 day, up to 57.8% for patients in the ICU for 21 or more days. For each day beyond 7 days in the ICU, there was an increased odds of death by 1 year of 1.04 (95% CI, 1.03-1.05) irrespective of the need for mechanical ventilation.
  
  
  CONCLUSIONS
  Increasing ICU length of stay is associated with higher 1-year mortality for both mechanically ventilated and non-mechanically ventilated patients. No specific cutoff was associated with a clear plateau or sharp increase in long-term risk.
authors.affiliation: 1Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY. 2ZD Associates, Perkasie, PA. 3Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 4Department of Anesthesiology, University of Toronto, Toronto, ON, Canada.
authors.forename: Vivek K
authors.initials: VK
authors.lastname: Moitra
authors.forename: Carmen
authors.initials: C
authors.lastname: Guerra
authors.forename: Walter T
authors.initials: WT
authors.lastname: Linde-Zwirble
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D010351:Patient Discharge; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014481:United States