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Patient Characteristics and Clinical and Economic Outcomes Associated with Unplanned Medical and Surgical Intensive Care Unit Admissions: A Retrospective Analysis

September 25, 2023

Purpose:
To characterize medical and surgical patient characteristics, as well as clinical and economic outcomes, associated with unplanned intensive care unit (ICU) admissions.
Patients and Methods:
This was a retrospective matched cohort analysis that utilized the PINC AI TM Healthcare Database, which collects deidentified data from 25% of United States (US) hospital admissions. Discharge records were assessed for medical and surgical admissions in 2021. An unplanned ICU admission was defined as direct transfer from a medical, surgical, or telemetry unit to the ICU. Patients with and without an unplanned ICU admission were 1:1 propensity score matched. Differences between patients with and without unplanned ICU admissions were assessed using two-sample t-tests for continuous measures and Chi-square tests for categorical measures
Results:
A total of 3,807,124 qualifying admissions were identified. Medical admissions with unplanned ICU transfers were more likely to be urgent/emergent (odds ratio [OR] 2.9, 95% confidence interval [CI 2.7–3.0], p<0.0001), with patient characteristics including male sex (1.4, [1.4–1.4], p<0.0001), obesity (1.7, [1.6–1.7], p<0.0001), and increased Charlson Comorbidity Index (CCI=1: 1.8, [1.8–1.9], p<0.0001; CCI≥5: 3.2, [3.1–3.3], p<0.0001). Surgical admissions with unplanned ICU transfers were more likely to be urgent/emergent (3.1, [2.9–3.2], p<0.0001) and with patients of higher CCI (2.5, [2.3–2.6], p<0.0001 to a CCI of≥5 (7.9, [7.4–8.4], p<0.0001). Between matched medical patients, mean differences in length of stay, cost, and mortality were 4.1 days (p<0.0001), $13,424 (p<0.0001), and 21% (p<0.0001), respectively. Between matched surgical patients, mean differences in these outcomes were 6.4 days (p<0.0001), $21,448 (p<0.0001), and 14% (p<0.0001), respectively. Conclusion:
Emergency care in patients with a higher co-morbid burden is more likely to lead to unplanned ICU admission, putting patients at a significantly increased chance of mortality, longer length of stay, and increased costs. Improving care and monitoring of patients outside the ICU may help detect early changes in pathophysiology and enable early intervention.
Plain Language Summary:
lthough unplanned intensive care unit (ICU) admissions from medical and surgical hospital units are common, the risk factors and outcomes associated with unplanned ICU admissions are not well-characterized. The purpose of this research was to examine the patient risk factors for unplanned ICU admissions and to calculate the impact of unplanned ICU transfers on patient length of stay, healthcare costs, and mortality. This research used a healthcare database that contains discharged patient data from 25% of United States (US) hospital admissions. The top risk factors for medical patients who had an unplanned ICU admission included emergency admissions (compared to pre-scheduled hospital admissions), male sex, obesity, and having one or more underlying disease. In surgical patients, the top risk factors for unplanned ICU admissions were emergency admissions (compared to pre-scheduled surgeries) and having one or more underlying disease. After risk adjustment, compared to medical patients without an unplanned ICU admission, medical patients with an unplanned ICU admission had significantly longer length of stay (4.1 days), higher cost ($13,424), and higher mortality (21%). Similarly, surgical patients with an unplanned ICU admission had longer length of stay (6.4 days), higher cost ($21,448), and higher mortality (14%) compared to surgical patients without unplanned ICU admission. Together, these results indicate that emergency care in patients with underlying disease is more likely to lead to an unplanned ICU admission. This puts patients at a higher chance of mortality, longer length of stay, and increased costs. Improving care and monitoring of patients outside of the ICU could enable clinicians to intervene early to reduce ICU transfers.
Keywords:
healthcare costs, length of stay, mortality, comorbidity