Hospital re-admission after critical care survival: a systematic review and meta-analysis.

J Mcpeake,T Quasim,T J Iwashyna,M Mikkelsen,M Bateson,C Robinson,P Cannon,F Christie,A H Leyland,M Shaw

doi:10.1111/anae.15644

Abstract

Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta-analysis to assess hospital re-admission rates following critical care admission and to explore potential re-admission risk factors. We searched the MEDLINE, Embase and CINAHL databases on 05 March 2020. Our search strategy incorporated controlled vocabulary and text words for hospital re-admission and critical illness, limited to the English language. Two reviewers independently applied eligibility criteria and assessed quality using the Newcastle Ottawa Score checklist and extracted data. The primary outcome was acute hospital re-admission in the year after critical care discharge. Of the 8851 studies screened, 87 met inclusion criteria and 41 were used within the meta-analysis. The analysis incorporated data from 3,897,597 patients and 741,664 re-admission episodes. Pooled estimates for hospital re-admission after critical illness were 16.9% (95%CI: 13.3-21.2%) at 30 days; 31.0% (95%CI: 24.3-38.6%) at 90 days; 29.6% (95%CI: 24.5-35.2%) at six months; and 53.3% (95%CI: 44.4-62.0%) at 12 months. Significant heterogeneity was observed across included studies. Three risk factors were associated with excess acute care rehospitalisation one year after discharge: the presence of comorbidities; events during initial hospitalisation (e.g. the presence of delirium and duration of mechanical ventilation); and subsequent infection after hospital discharge. Hospital re-admission is common in survivors of critical illness. Careful attention to the management of pre-existing comorbidities during transitions of care may help reduce healthcare utilisation after critical care discharge. Future research should determine if targeted interventions for at-risk critical care survivors can reduce the risk of subsequent rehospitalisation.

Highlights

Survivorship after critical illness brings challenges to patients and their primary caregivers in the months after hospital discharge [1, 2]
This review has shown that acute rehospitalisation following critical care is common, with up to half of critical care survivors experiencing acute hospital re-admission in the year following discharge
Our analysis demonstrated that this population of critical care survivors experience high levels of ongoing needs after their initial illness episode

Summary

Introduction

Survivorship after critical illness brings challenges to patients and their primary caregivers in the months after hospital discharge [1, 2]. These include physical, social, emotional and cognitive problems [3–6]. Critical care survivors frequently require access to outpatient and acute inpatient hospital resources in the post-discharge period [7, 8]. Hospital re-admission may cause distress for individual patients and their caregivers; and increase strain on the healthcare system [9, 10]. For patients who survive critical care, it is not currently clear what proportion of hospital re-admissions are potentially preventable nor the proportion that indicate terminal decline, as observed in other sub-groups of the population (e.g. older adults) [11]. There is a need to synthesise the current evidence base, to inform future interventional work in the field

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Discussion

Conclusion