title: Mortality and readmission of outcomes after discharge from the surgical intensive care unit to long-term, acute-care hospitals.
abstract: Patients with prolonged hospitalizations in the surgical intensive care unit often have ongoing medical needs that require further care at long-term, acute-care hospitals upon discharge. Setting expectations for patients and families after protracted operative intensive care unit hospitalization is challenging, and there are limited data to guide these conversations. The purpose of this study was to determine patient survival and readmission rates after discharge from the surgical intensive care unit directly to a long-term, acute-care hospital.
  
  
  
  All patients who were admitted to the surgical intensive care unit at an academic, tertiary care medical center from 2009-2014 and discharged directly to long-term, acute-care hospitals were retrospectively reviewed. Patients represented all surgical subspecialties excluding cardiac and vascular surgery patients. Primary outcomes included 30-day readmission, and 1- and 3-year mortality rates following discharge.
  
  
  
  In total, 296 patients were discharged directly from the surgical intensive care unit to a long-term, acute-care hospital during the study period. There were 190 men (64%) and mean age was 61 ± 16 years. Mean duration of stay in the surgical intensive care unit was 27 ± 17 days. The most frequent complication was prolonged mechanical ventilation (277, 94%) followed by pneumonia (139, 47%), sepsis (78, 26%), and acute renal failure (32, 11%); 93% of patients required tracheostomy and enteral feeding access prior to discharge, and 19 patients (6%) were newly dependent on hemodialysis. The readmission rate was 20%. There were 86 deaths within 1 year from discharge (29%) with an overall 3-year mortality of 32%. In a multiple logistic regression analysis, a history of end-stage renal disease had a greater odds of readmission (odds ratio 6.07, P = .028). Patients with history of cancer had greater odds of 1- and 3-year mortality (odds ratio = 2.99, P = .028 and odds ratio 2.56, P = .053, respectively), and patients with a neurologic diagnosis had greater odds of 3-year mortality (odds ratio 4.69, P = .031). Readmission significantly increased the odds of 1- and 3-year mortality (odds ratio 3.12, P = .020 and odds ratio 2.90, P = .027, respectively). Patients who had both private insurance and Medicare had greater odds of 1- and 3-year mortality (odds ratio 10.39, P = .005 and odds ratio 10.65, P = .004, respectively).
  
  
  
  Patients who are discharged to long-term, acute-care hospitals have prolonged hospitalizations with high complication rates. These patients have high readmission and 1-year mortality rates. Patients and families should be counseled regarding these outcomes related to post-intensive care unit recovery after discharge to a long-term, acute-care hospital to allow for realistic expectations of survival after prolonged intensive care unit hospitalization.
authors.affiliation: The Ohio State University Medical Center, Columbus, OH. Electronic address: michelle.nguyen@osumc.edu.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Nguyen
authors.affiliation: The Ohio State University Medical Center, Columbus, OH.
authors.forename: David S
authors.initials: DS
authors.lastname: Strosberg
authors.affiliation: The Ohio State University Medical Center, Columbus, OH.
authors.forename: Teresa S
authors.initials: TS
authors.lastname: Jones
authors.affiliation: The Ohio State University Medical Center, Columbus, OH.
authors.forename: Ankur
authors.initials: A
authors.lastname: Bhakta
authors.affiliation: The Ohio State University Medical Center, Columbus, OH.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Jones
authors.affiliation: The Ohio State University Medical Center, Columbus, OH.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lyaker
authors.affiliation: The Ohio State University Medical Center, Columbus, OH.
authors.forename: Cindy A
authors.initials: CA
authors.lastname: Byrd
authors.affiliation: The Ohio State University Medical Center, Columbus, OH.
authors.forename: Carly
authors.initials: C
authors.lastname: Sobol
authors.affiliation: The Ohio State University Medical Center, Columbus, OH.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Eiferman
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate