Critical Care
Medicine: April 2016 -
Volume 44 - Issue 4 - p 655–662
Moitra, V et al
Objectives: 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.
Design: 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. Interventions: None. Patients: The cohort
included 34,696 Medicare beneficiaries older than 65 years who received
intensive care and survived to hospital discharge in 2005. Measurements and
Main 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
cut off was associated with a clear plateau or sharp increase in long-term
risk.
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