Journal
AMERICAN JOURNAL OF THE MEDICAL SCIENCES
Volume 341, Issue 5, Pages 373-377Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MAJ.0b013e31820ab4f6
Keywords
Critical care; Rehabilitation; Acute respiratory failure; Long-term outcomes; Mobility
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Funding
- NIA NIH HHS [P60AG10484] Funding Source: Medline
- NINR NIH HHS [1R01NR011186-01, R01 NR011186-01, R01 NR011186] Funding Source: Medline
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Introduction: Hospitals are under pressure to provide care that not only shortens hospital length of stay but also reduces subsequent hospital admissions. Hospital readmissions have received increased attention in outcome reporting. The authors identified survivors of acute respiratory failure who then required subsequent hospitalization. A cohort of acute respiratory failure survivors, who participated in an early intensive care unit (ICU) mobility program, was assessed to determine if variables from the index hospitalization predict hospital readmission or death, within 12 months of hospital discharge. Methods: Hospital database and responses to letters mailed to 280 acute respiratory failure survivors. Univariate predictor variables shown to be associated with hospital readmission or death (P < 0.1) were included in a multiple logistic regression. A stepwise selection procedure was used to identify significant variables (P < 0.05). Results: Of the 280 survivors, 132 (47%) had at least 1 readmission or died within the first year, 126 (45%) were not readmitted and 22 (8%) were lost to follow-up. Tracheostomy [odds ratio (OR), 4.02 (95% CI, 1.72-9.40)], female gender [OR, 1.94 (95% CI, 1.13-3.32)], a higher Charlson Comorbidity Index assessed upon index hospitalization discharge [OR, 1.15 (95% CI, 1.01-1.31)] and lack of early ICU mobility therapy [OR, 1.77 (95% CI, 1.04-3.01)] predicted readmission or death in the first year postindex hospitalization. Conclusions: Tracheostomy, female gender, higher Charlson Comorbidity Index and lack of early ICU mobility were associated with readmissions or death during the first year. Although the mechanisms of increased hospital readmission are unclear, these findings may provide further support for early ICU mobility for patients with acute respiratory failure.
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