title: Long-Term Outcomes and Health Care Utilization after Prolonged Mechanical Ventilation.
abstract: BACKGROUND
  Limited data are available to characterize the long-term outcomes and associated costs for patients who require prolonged mechanical ventilation (PMV; defined here as mechanical ventilation for longer than 21 d).
  
  
  OBJECTIVE
  To examine the association between PMV and mortality, health care utilization, and costs after critical illness.
  
  
  METHODS
  Population-based cohort study of adults who received mechanical ventilation in an intensive care unit (ICU) in Ontario, Canada between 2002 and 2013.
  
  
  RESULTS
  We used linked administrative databases to determine discharge disposition, and ascertain 1-year mortality (primary outcome), readmissions to hospital and ICU, and health care costs for hospital survivors. Overall, 11,594 (5.4%) patients underwent PMV, with 42.4% of patients dying in the hospital (vs. 27.6% of patients who did not undergo prolonged ventilation; P < 0.0001). Patients on prolonged ventilation were more frequently discharged to other facilities or home with health care support (84.8 vs. 43.5%, P < 0.0001). Among hospital survivors, estimated mortality was higher for patients who underwent PMV: 16.6 versus 11% at 1 year and 42.0 versus 30.4% at 5 years. At 1 year after hospital discharge, patients on prolonged ventilation had higher rates of hospital readmission (47.2 vs. 37.7%; adjusted odds ratio = 1.20; 95% confidence interval = 1.14-1.26), ICU readmission (19.0 vs. 11.6%; adjusted odds ratio = 1.49; 95% confidence interval: 1.39, 1.60), and total health care costs: median (interquartile range) Can $32,526 ($20,821-$56,102) versus Can $13,657 ($5,946-$38,022). Increasing duration of mechanical ventilation was associated with higher mortality and health care utilization.
  
  
  CONCLUSIONS
  Critically ill patients who undergo mechanical ventilation in an ICU for longer than 21 days have high in-hospital mortality and greater postdischarge mortality, health care utilization, and health care costs compared with patients who undergo mechanical ventilation for a shorter period of time.
authors.affiliation: 1 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.|2 Sunnybrook Research Institute, Toronto, Ontario, Canada.
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Hill
authors.affiliation: 1 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.|2 Sunnybrook Research Institute, Toronto, Ontario, Canada.|3 Interdepartmental Division of Critical Care and.|4 Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fowler
authors.affiliation: 3 Interdepartmental Division of Critical Care and.|4 Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|5 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
authors.forename: Karen E A
authors.initials: KE
authors.lastname: Burns
authors.affiliation: 1 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.|6 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.|7 West Park Healthcare Centre, Toronto, Ontario, Canada; and.|8 Provincial Centre of Weaning Excellence, Toronto East General Hospital, Toronto, Ontario, Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Rose
authors.affiliation: 1 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Ruxandra L
authors.initials: RL
authors.lastname: Pinto
authors.affiliation: 1 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.|2 Sunnybrook Research Institute, Toronto, Ontario, Canada.|3 Interdepartmental Division of Critical Care and.|4 Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Damon C
authors.initials: DC
authors.lastname: Scales
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012121:Respiration, Artificial; D017678:Sex Distribution; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
keywords: critical care; health care utilization; mechanical ventilation; outcome assessment