Preventable readmission to intensive care unit in critically ill cancer patients

doi:10.5847/wjem.j.1920-8642.2018.03.008

Abstract

Abstract:

BACKGROUND: Readmission to intensive care unit (ICU) after discharge to ward has been reported to be associated with increased hospital mortality and longer length of stay (LOS). The objective of this study was to investigate whether ICU readmission are preventable in critically ill cancer patients.
METHODS: Data of patients who readmitted to intensive care unit (ICU) at National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC) between January 2013 and November 2016 were retrospectively collected and reviewed.
RESULTS: A total of 39 patients were included in the final analysis, and the overall readmission rate between 2013 and 2016 was 1.32% (39/2,961). Of 39 patients, 32 (82.1%) patients were judged as unpreventable and 7 (17.9%) patients were preventable. There were no significant differences in duration of mechanical ventilation, ICU LOS, hospital LOS, ICU mortality and in-hospital mortality between patients who were unpreventable and preventable. For 24 early readmission patients, 7 (29.2%) patients were preventable and 17 (70.8%) patients were unpreventable. Patients who were late readmission were all unpreventable. There was a trend that patients who were preventable had longer 1-year survival compared with patients who were unpreventable (100% vs. 66.8%, log rank=1.668, P=0.196).
CONCLUSION: Most readmission patients were unpreventable, and all preventable readmissions occurred in early period after discharge to ward. There were no significant differences in short term outcomes and 1-year survival in critically ill cancer patients whose readmissions were preventable or not.

Key words: Readmission, Cancer, Preventability, Outcomes

Hai-jun Wang, Yong Gao, Shi-ning Qu, Chu-lin Huang, Hao Zhang, Hao Wang, Quan-hui Yang, Xue-zhong Xing. Preventable readmission to intensive care unit in critically ill cancer patients[J]. World Journal of Emergency Medicine, 2018, 9(3): 211-215.

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References 18

[1]	Nishi GK, Suh RH, Wilson MT, Cunneen SA, Margulies DR, Shabot MM. Analysis of causes and prevention of early readmission to surgical intensive care. Am Surg. 2003; 69(10):913-7. pmid: 14570374
[2]	Kaben A, Corrêa F, Reinhart K, Settmacher U, Gummert J, Kalff R, et al. Readmission to a surgical intensive care unit: incidence, outcome and risk factors. Crit Care. 2008; 12(5):R123. pmid: 18838006
[3]	Renton J, Pilcher DV, Santamaria JD, Stow P, Bailey M, Hart G, et al. Factors associated with increased risk of readmission to intensive care in Australia. Intensive Care Med. 2011; 37(11):1800-8. doi: 10.1007/s00134-011-2318-x pmid: 21845504
[4]	Kramer AA, Higgins TL, Zimmerman JE. Intensive care unit readmissions in U.S. hospitals: patient characteristics, risk factors, and outcomes. Crit Care Med. 2012; 40(1):3-10. doi: 10.1097/CCM.0b013e31822d751e pmid: 21926603
[5]	Xing XZ, Gao Y, Wang HJ, Qu SN, Huang CL, Zhang H, et al. Assessment of a predictive score for pulmonary complications in cancer patients after esophagectomy. World J Emerg Med. 2016; 7(1):44-9. pmid: 27006738
[6]	Bice T. ICU readmissions: good for reflection on performance but not a reflection of quality. Crit Care Med. 2016; 44(9):1790-1. doi: 10.1097/CCM.0000000000001809 pmid: 27526001
[7]	Rosa RG, Roehrig C, de Oliveira RP, Maccari JG, Antônio AC, de Souza Castro P, et al. Correction: Comparison of unplanned intensive care unit readmission scores: a prospective cohort study. PLoS ONE. 2016,11(2):e0148834. doi: 10.1371/journal.pone.0148834 pmid: 26849122
[8]	Brown SES, Ratcliffe SJ, Halpern SD. Assessing the utility of ICU readmissions as a quality metric: an analysis of changes mediated by residency work-hour reforms. Chest. 2015; 147(3):626-36. doi: 10.1378/chest.14-1060 pmid: 25393027
[9]	Santamaria JD, Duke GJ, Pilcher DV, Cooper DJ, Moran J, Bellomo R. Readmissions to intensive care: a prospective multicenter study in Australia and New Zealand. Crit Care Med. 2017; 45(2):290-7. pmid: 27632681
[10]	Al-Jaghbeer MJ, Tekwani SS, Gunn SR, Kahn JM. Incidence and etiology of potentially preventable ICU readmissions. Crit Care Med. 2016; 44(9):1704-9. doi: 10.1097/CCM.0000000000001746 pmid: 27071066
[11]	Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. doi: 10.1001/jama.2016.0287 pmid: 26903338
[12]	Kellum JA, Lameire N. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013; 17(1):204. doi: 10.1186/cc11454 pmid: 23394211
[13]	Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012; 307(23):2526-33. pmid: 22797452
[14]	Xing XZ, Gao Y, Wang HJ, Yang QH, Huang CL, Qu SN, et al. Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency. World J Emerg Med. 2013; 4(1):43-7. doi: 10.5847/wjem.j.issn.1920-8642.2013.01.008 pmid: 25215091
[15]	Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med. 2005; 31(10):1345-55. doi: 10.1007/s00134-005-2763-5 pmid: 16132892
[16]	Auerbach AD, Kripalani S, Vasilevskis EE, Sehgal N, Lindenauer PK, Metlay JP, et al. Preventability and causes of readmissions in a national cohort of general medicine patients. JAMA Intern Med. 2016; 176(4):484-93. pmid: 26954564
[17]	Snow N, Bergin KT, Horrigan TP. Readmission of patients to the surgical intensive care unit: patient profiles and possibilities for prevention. Crit Care Med. 1985; 13(11):961-4. doi: 10.1097/00003246-198511000-00037 pmid: 4053645
[18]	Cooper GS, Sirio CA, Rotondi AJ, Shepardson LB, Rosenthal GE. Are readmissions to the intensive care unit a useful measure of hospital performance? Med Care. 1999; 37(4):399-408. pmid: 10213020

Clinical characteristics	Value (n=39)
Age (years)	60 (54-72)
Male gender, n (%)	29 (74.4)
Comorbidities
History of hypertension, n (%)	14 (35.9)
History of coronary heart disease, n(%)	5 (12.9)
History of diabetic mellitus, n (%)	7 (17.9)
SAPS 3 at first admission	41 (31-51)
SOFA at first admission	2 (2-4)
Length of time on ward prior to readmission (hours)	43 (24-128)
Mechanical ventilation during ICU, n(%)	36 (92.3)
Presence of ARDS during ICU, n (%)	4 (10.3)
Presence of AKI during ICU, n (%)	7 (17.9)
Presence of sepsis and septic shock during ICU, n (%)	29 (74.4)
Duration of mechanical ventilation (days)	5 (2-14)
ICU length of stay (days)	10 (6-16)
ICU mortality, n (%)	6 (15.4)
Hospital length of stay (days)	28 (21-51)
Hospital mortality, n (%)	6 (15.4)

Reasons	First admission (n=39)	Readmission (n=39)	Pvalue
Pulmonary	30 (76.9)	28 (71.8)	0.604
Cardiovascular	5 (12.8)	8 (20.5)	0.362
Neurological	2 (5.1)	2 (5.1)	1.000
Endocrine	2 (5.1)	0	0.474
Infectious disease	0	1 (2.6)	0.314

Clinical variables	Unpreventable (n=32)	Preventable (n=7)	Pvalue
Duration of mechanical ventilation (days)	6.5 (2.0-13.8)	5.0 (1.0-25.0)	0.599
ICU length of stay (days)	10.0 (5.0-15.5)	14.0 (11.0-31.0)	0.054
ICU mortality (%)	6 (18.8)	0	0.568
Hospital length of stay (days)	27.0 (20.3-41.8)	28.0 (24.0-61.0)	0.882
Hospital mortality (%)	6 (18.8)	0	0.568

Time	Unpreventable (n=32)	Preventable (n=7)	Pvalue
Early readmission	17 (53.1)	7 (100)	0.021
Late readmission	15 (46.9)	0	0.021