Abstract
Prolonged admissions to an ICU are associated with high resource utilization and personal cost to the patient. Previous reports suggest increasing length of stay may be associated with poor outcomes. Conditional survival represents the probability of future survival after a defined period of treatment on an ICU providing a description of how prognosis evolves over time. Our objective was to describe conditional survival as length of ICU stay increased. Retrospective observational cohort study of three large intensive care databases. Three intensive care databases, two in the United States (Medical Information Mart for Intensive Care III and electronic ICU) and one in United Kingdom (Post Intensive Care Risk-Adjusted Alerting and Monitoring). Index admissions to intensive care for patients 18 years or older. None. A total of 11,648, 38,532, and 165,125 index admissions were analyzed from Post Intensive Care Risk-Adjusted Alerting and Monitoring, Medical Information Mart for Intensive Care III and electronic ICU databases respectively. In all three cohorts, conditional survival declined over the first 5-10 days after ICU admission and changed little thereafter. In patients greater than or equal to 75 years old conditional survival continued to decline with increasing length of stay. After an initial period of 5-10 days, probability of future survival does not appear to decrease with increasing length of stay in unselected patients admitted to ICUs in United Kingdom and United States [corrected]. These findings were consistent between the three populations and suggest that a prolonged admission to an ICU is not a reason for a pessimism in younger patients but may indicate a poor prognosis in the older population.
Highlights
The use of three independent databases allows us to limit bias that may exist within one dataset and further to demonstrate whether findings are consistent between the United Kingdom and North America, where different healthcare systems are in place and ICUs admit a different case-mix
Conditional survival declined over the initial 5–10 days but plateaued prior to day 10 (Fig. 1)
In an observational retrospective study of three intensive care databases, we have demonstrated that in unselected patients admitted to an ICU, after an initial period of 5–10 days conditional survival to hospital discharge does not decrease with length of ICU stay
Summary
Prolonged admissions to an ICU are associated with high resource utilization and personal cost to the patient. Previous reports suggest increasing length of stay may be associated with. Drs Marshall, Young, and Watkinson designed the study. Drs Marshall and Hatch and Mr Gerry conducted the analysis. All authors were responsible for interpreting the data and drafting of the article
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