Dataset Information

The impact of adverse events in the intensive care unit on hospital mortality and length of stay.

ABSTRACT:

Background

Adverse events (AEs) are patient injuries caused by medical care. Previous studies have reported increased mortality rates and prolonged hospital length of stay in patients having an AE. However, these studies have not adequately accounted for potential biases which might influence these associations. We performed this study to measure the independent influence of intensive care unit (ICU) based AEs on in-hospital mortality and hospital length of stay.

Methods

Prospective cohort study in an academic tertiary-care ICU. Patients were monitored daily for adverse clinical occurrences. Data about adverse clinical occurrences were reviewed by a multidisciplinary team who rated whether they were AEs and whether they were preventable. We determined the association of AEs in the ICU with time to death and time to hospital discharge using multivariable survival analysis models.

Results

We evaluated 207 critically ill patients (81% required mechanical ventilation, median Glasgow Coma Scale = 8, median predicted mortality = 31%). Observed mortality rate and hospital length of stay were 25% (95% CI 19%-31%) and 15 days (IQR 8-34 days), respectively. ICU-based AEs and preventable AEs occurred in 40 patients (19%, 95% CI 15%-25%) and 21 patients (10%, 95% CI 7%-15%), respectively. ICU-based AEs and preventable AEs were not significantly associated with time to in-hospital death (HR = 0.93, 95% CI 0.44-1.98 and HR = 0.72 95% CI 0.25-2.04, respectively). ICU-based AEs and preventable AEs were independently associated with time to hospital discharge ((HR = 0.50, 95% CI 0.31-0.81 and HR = 0.46 95% CI 0.23-0.91, respectively)). ICU-based AEs were associated with an average increase in hospital length of stay of 31 days.

Conclusion

The impact of AEs on hospital length of stay was clinically relevant. Larger studies are needed to conclusively measure the association between preventable AEs and patient outcomes.

SUBMITTER: Forster AJ

PROVIDER: S-EPMC2621200 | biostudies-literature | 2008 Dec

REPOSITORIES: biostudies-literature

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Publications

The impact of adverse events in the intensive care unit on hospital mortality and length of stay.

Forster Alan J AJ Kyeremanteng Kwadwo K Hooper Jon J Shojania Kaveh G KG van Walraven Carl C

BMC health services research 20081217

<h4>Background</h4>Adverse events (AEs) are patient injuries caused by medical care. Previous studies have reported increased mortality rates and prolonged hospital length of stay in patients having an AE. However, these studies have not adequately accounted for potential biases which might influence these associations. We performed this study to measure the independent influence of intensive care unit (ICU) based AEs on in-hospital mortality and hospital length of stay.<h4>Methods</h4>Prospecti ...[more]

PMID: 19091089

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Project description:ObjectiveSeveral studies show that chronic opioid dependence leads to higher in-hospital mortality, increased risk of hospital readmissions, and worse outcomes in trauma cases. However, the association of outpatient prescription opioid use on morbidity and mortality has not been adequately evaluated in a critical care setting. The purpose of this study was to determine if there is an association between chronic opioid use and mortality after an ICU admission.DesignA single-center, longitudinal retrospective cohort study of all Intensive Care Unit (ICU) patients admitted to a tertiary-care academic medical center from 2001 to 2012 using the MIMIC-III database.SettingMedical Information Mart for Intensive Care III database based in the United States.PatientsAdult patients 18 years and older were included. Exclusion criteria comprised of patients who expired during their hospital stay or presented with overdose; patients with cancer, anoxic brain injury, non-prescription opioid use; or if an accurate medication reconciliation was unable to be obtained. Patients prescribed chronic opioids were compared with those who had not been prescribed opioids in the outpatient setting.InterventionsNone.Measurements and main resultsThe final sample included a total of 22,385 patients, with 2,621 (11.7%) in the opioid group and 19,764 (88.3%) in the control group. After proceeding with bivariate analyses, statistically significant and clinically relevant differences were identified between opioid and non-opioid users in sex, length of hospital stay, and comorbidities. Opioid use was associated with increased mortality in both the 30-day and 1-year windows with a respective odds ratios of 1.81 (95% CI, 1.63-2.01; p<0.001) and 1.88 (95% CI, 1.77-1.99; p<0.001), respectively.ConclusionsChronic opioid usage was associated with increased hospital length of stay and increased mortality at both 30 days and 1 year after ICU admission. Knowledge of this will help providers make better choices in patient care and have a more informed risk-benefits discussion when prescribing opioids for chronic usage.

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Dataset Information

The impact of adverse events in the intensive care unit on hospital mortality and length of stay.

Background

Methods

Results

Conclusion

Publications

The impact of adverse events in the intensive care unit on hospital mortality and length of stay.

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