Readmissions to General ICUs in a Geographic Area of Poland Are Seemingly Associated with Better Outcomes.

Marek Grochla,Piotr Knapik,Wojciech Saucha,Daniel Ciesla

doi:10.3390/ijerph17020565

Abstract

Background: Various factors can contribute to high mortality rates in intensive care units (ICUs). Here, we intended to define a population of patients readmitted to general ICUs in Poland and to identify independent predictors of ICU readmission. Methods: Data derived from adult ICU admissions from the Silesian region of Poland were analyzed. First-time ICU readmissions (≤30 days from ICU discharge after index admissions) were compared with first-time ICU admissions. Pre-admission and admission variables that independently influenced the need for ICU readmission were identified. Results: Among the 21,495 ICU admissions, 839 were first-time readmissions (3.9%). Patients readmitted to the ICU had lower mean APACHE II (21.2 ± 8.0 vs. 23.2 ± 8.8, p < 0.001) and TISS-28 scores (33.7 ± 7.4 vs. 35.2 ± 7.8, p < 0.001) in the initial 24 h following ICU admission, compared to first-time admissions. ICU readmissions were associated with lower mortality vs. first-time admissions (39.2% vs. 44.3%, p = 0.004). Independent predictors for ICU readmission included the admission from a surgical ward (among admission sources), chronic respiratory failure, cachexia, previous stroke, chronic neurological diseases (among co-morbidities), and multiple trauma or infection (among primary reasons for ICU admission). Conclusions: High mortality associated with first-time ICU admissions is associated with a lower mortality rate during ICU readmissions.

Highlights

Readmission to an intensive care unit (ICU) is perceived to be associated with high mortality rates
High mortality associated with first-time ICU admissions is associated with a lower mortality rate during ICU readmissions
The aims of this study were to identify a population of patients readmitted to general ICUs in Poland, to compare their course of treatment with the remaining population, and to identify independent predictors of ICU readmission

Summary

Introduction

Readmission to an intensive care unit (ICU) is perceived to be associated with high mortality rates. Results of recent studies indicate that ICU mortality in Poland is higher than in other European countries [6,7]; this is not due to inferior quality of care [8] and is appropriate for the patients’ condition upon ICU admission as assessed using the APACHE II and SAPS III scoring systems [9]. This phenomenon may be primarily associated with the liberal ICU admission policy for patients with a limited chance of survival; no research has yet been conducted in Poland to address this issue. Results: Among the 21,495 ICU admissions, 839 were first-time readmissions (3.9%)

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