title: Long-term outcomes and healthcare utilization following critical illness--a population-based study.
abstract: BACKGROUND
  The purpose of this study was to examine hospital mortality, long-term mortality, and health service utilization among critically ill patients. We also determined whether these outcomes differed according to demographic and clinical characteristics.
  
  
  METHODS
  We conducted a retrospective cohort study of adults (age ≥ 18 years) who survived admission to an intensive care unit (ICU) in Ontario, Canada, between 1 April 2002 and 31 March 2012, excluding isolated admissions to step-down or intermediate ICUs, coronary care ICUs, or cardiac surgery ICUs. Adults (age ≥ 18 years) who survived an acute hospitalization that did not include an ICU stay formed the comparator group. The primary outcome was mortality following hospital discharge. Secondary outcomes were healthcare utilization, including emergency room admissions and hospital readmissions during follow-up.
  
  
  RESULTS
  Over the study interval, 500,124 patients were admitted to ICUs and 420,187 (84%) survived to hospital discharge. Median follow-up for survivors was 5.3 (interquartile range 2.5, 8.2) years. Patients admitted to an ICU were more likely to subsequently visit the emergency department, be readmitted to the hospital and ICU, receive home care support, require rehabilitation, and be admitted for long-term care. Those requiring more resources within the ICU required more resources after discharge. One-third of patients admitted to the ICU died during long-term follow-up, with overall probabilities of death of 11% and 29% at 1 year and 5 years, respectively. In the adjusted analysis, there was an increasing hazard of death with increasing age, reaching a hazard ratio of 18.08 (95 % confidence interval 16.60-19.68) for those ≥ 85 years of age compared with those aged 18-24 years.
  
  
  CONCLUSIONS
  Healthcare utilization after hospital discharge was higher among ICU patients, and also among those requiring more healthcare resources during their ICU admission, than among all hospitalized patients as a group. One-third of ICU patients died within the 5 years following discharge, and age was the most influential determinant of outcome. These findings should help target post-ICU discharge services for high-risk groups and better inform goals-of-care discussions for elderly critically ill patients.
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. Andrea.Hill@Sunnybrook.ca.|Sunnybrook Research Institute, Toronto, ON, Canada. Andrea.Hill@Sunnybrook.ca.
authors.forename: A D
authors.initials: AD
authors.lastname: Hill
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.|Sunnybrook Research Institute, Toronto, ON, Canada.|Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
authors.forename: R A
authors.initials: RA
authors.lastname: Fowler
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Pinto
authors.affiliation: Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.|Toronto General Hospital/University Health Network, Toronto, ON, Canada.
authors.forename: M S
authors.initials: MS
authors.lastname: Herridge
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.|Sunnybrook Research Institute, Toronto, ON, Canada.|Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
authors.forename: B H
authors.initials: BH
authors.lastname: Cuthbertson
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.|Sunnybrook Research Institute, Toronto, ON, Canada.|Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
authors.forename: D C
authors.initials: DC
authors.lastname: Scales
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D063868:Patient Outcome Assessment; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017741:Survivors / Q000706:statistics & numerical data
keywords: Critical care; Healthcare utilization; Outcomes