Association between time of discharge from ICU and hospital mortality: a systematic review and meta-analysis.

Si Yang,Lijun Ma,Zheng Wang,Jinlai Wang,Zhida Liu

doi:10.1186/s13054-016-1569-x

Si Yang, Lijun Ma + Show 3 more

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https://doi.org/10.1186/s13054-016-1569-x

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Abstract

BackgroundEpidemiological studies have provided inconsistent results on whether intensive care unit (ICU) discharge at night and on weekends is associated with an increased risk of mortality. This systematic review and meta-analysis aimed to determine whether ICU discharge time was associated with hospital mortality.MethodsThe PubMed, Embase, and Scopus databases were searched to identify cohort studies that investigated the effects of discharge from the ICU on weekends and at night on hospital mortality, with adjustments for the disease severity at ICU admission or discharge. The primary meta-analysis focused on the association between nighttime ICU discharge and hospital mortality. The secondary meta-analysis examined the association between weekend ICU discharge and hospital mortality. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model.ResultsWe included 14 studies that assessed outcomes for nighttime versus daytime discharges among 953,312 individuals. Of these 14 studies, 5 evaluated outcomes for weekend versus weekday discharges (n = 70,883). The adjusted OR for hospital mortality was significantly higher among patients discharged during the nighttime, compared to patients discharged during the daytime (OR 1.31, 95% CI 1.25–1.38, P < 0.0001), and the studies exhibited low heterogeneity (I 2 = 33.8%, P = 0.105). There was no significant difference in the adjusted ORs for hospital mortality between patients discharged during the weekend or on weekdays (OR 1.03, 95% CI 0.88–1.21, P = 0.68), although there was significant heterogeneity between the studies in the weekday/weekend analysis (I 2 = 72.5%, P = 0.006).ConclusionsNighttime ICU discharge is associated with an increased risk of hospital mortality, while weekend ICU discharge is not. Given the methodological limitations and heterogeneity among the included studies, these conclusions should be interpreted with caution, and should be tested in further studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1569-x) contains supplementary material, which is available to authorized users.

Highlights

Epidemiological studies have provided inconsistent results on whether intensive care unit (ICU) discharge at night and on weekends is associated with an increased risk of mortality
The adjusted odds ratio (OR) for hospital mortality was significantly higher among patients discharged during the nighttime, compared to patients discharged during the daytime (Fig. 2), and the individual studies had low heterogeneity (I2 = 33.8%, P = 0.105)
The present meta-analysis revealed that nighttime ICU discharge was associated with an increased risk of hospital mortality, compared to daytime discharge

Summary

Introduction

Epidemiological studies have provided inconsistent results on whether intensive care unit (ICU) discharge at night and on weekends is associated with an increased risk of mortality. The greatest risk of death is related to the intensive care unit (ICU) admission, triage, and discharge, with up to 10.8% of patients dying after being. Yang et al Critical Care (2016) 20:390 highlighted the risks of adverse outcomes that may be associated with nighttime ICU discharge. These unfavorable outcomes may include greater in-hospital mortality [6, 10], a higher unplanned ICU readmission rate [9, 13], and prolonged hospitalization [13]. Several other studies, including the most recent large-scale prospective study, failed to draw similar conclusions [14, 15], and similar inconsistencies have been observed in studies of whether weekend discharge is harmful [8, 10, 12, 14, 16]

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