BJA Advance Access originally published online on December 22, 2007
British Journal of Anaesthesia 2008 100(2):219-223; doi:10.1093/bja/aem372
Long-term functional outcome and performance status after intensive care unit re-admission: a prospective survey
1 Department of Anaesthesia and Intensive Care, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
2 Department of Preventive and Social Medicine, Dunedin School of Medicine, PO Box 913, Dunedin 9054, New Zealand
* Corresponding author. E-mail: tallniamh{at}hotmail.com
Background: Intensive care unit (ICU) re-admission identifies a high-risk group in terms of hospital mortality, length of stay, and resource utilization. Only hospital and ICU mortality are well described in the literature on critically ill patients needing re-admission.
Methods: With ethical committee approval, from a prospectively collected database of all admissions to a combined medical and surgical ICU from January 1 to December 31, 2004, we identified all ICU re-admissions from within the hospital and analysed the factors associated with increased incidence of re-admission. At 2–3 yr after discharge, we evaluated the functional outcome of the surviving re-admitted patients as Glasgow Outcome Score (GOS) and Karnofsky index and identified determinants of both mortality and good functional outcome.
Results: Seventy-three (7.4%) of the 1061 patients who survived their first ICU stay were re-admitted during the study period. Of the 73 re-admitted patients, 14 died in ICU, 17 died later in the same hospital stay, and 10 died in the interim. Thus, 32 (43.8%) were alive 2–3 yr after discharge. The median [IQR] GOS of the survivors was 4 (see Mackle and colleagues in One year outcome of intensive care patients with decompensated alcoholic liver disease. Br J Anaesth 2006; 97: 496–8 and Jennett and Bond in Assessment of outcome after severe brain damage. A practical scale. Lancet 1975; 1: 480–4) and their median Karnofsky index was 70 [70–90] at follow-up. The only independent predictors of favourable functional outcome at follow-up were lower Apache 2 scores on both first ICU admission and on re-admission.
Conclusions: Although the ICU, hospital, and subsequent mortalities are high in patients after ICU re-admission, most survivors at 2–3 yr had by then made a good functional recovery and were independent.
Keywords: complications; intensive care; recovery