Among critically ill patients who survived an intensive care unit (ICU) stay, 89% returned home for a median of 330 days. At 1 year post ICU discharge, 77% of patients were still at home and 17% of patients had died. These were among study findings published in Chest.
Investigators sought to report outcomes and health care trajectories 1-year post ICU discharge among adult patients who had received care in a French ICU. To accomplish this, the researchers analyzed state sequence analysis and data from the National Health Data System (Système National des Données de Santé [SNDS]).
The study included adults admitted to a French ICU during 2018 for at least 2 consecutive nights who required invasive mechanical ventilation and/or vasopressors or inotropes. Only patients who were discharged alive after the index ICU admission were included in the analysis.
A daily state sequence (ie, a profile that included the succession of events defining the patient’s trajectory) was created for each patient to analyze care pathways in the 365 days preceding and the 365 days following ICU discharge. An unsupervised clustering method was used to identify groups of patients with similar trajectories after ICU discharge using the post-ICU weekly state sequences.
Data from 77,132 patients were included in the analysis. Their median (interquartile range) age was 67 years (57-75), and 64.7% were male. The median length of index acute care hospital (ACH) stay (including contiguous ACH stays) was 18 days (11-33). The median ICU length of stay was 5 days (3-10), with 24% of ICU stays longer than 10 days.
Of the patients discharged alive from the index ICU stay, 4360 (5.7%), 6124 (7.9%), and 7424 (9.6%) died within 30, 60, and 90 days post-ICU discharge, respectively. The median duration before death was 71 (19-180) days, and 6% of participants (n=4615) died during the index ACH stay (and contiguous ACH stays). In addition, 89% of patients returned home in the year after ICU discharge for a median cumulative duration of 330 (283-349) days.
In the 1-year follow-up, 51% of patients required re-hospitalization in an ACH for a median of 11 (4-25) days, and 10% required an ICU readmission for 5 (2-11) days. During the year before the index ICU stay, 99% were at home for a median cumulative duration of 351 (333-358) days, 56% were hospitalized in an ACH for a median of 7 (3-18) days, and 4.9% were admitted to an ICU for a median of 4 (2-9) days.
The researchers identified 3 clusters of patients with distinct characteristics and outcomes. Cluster 1 (n=52,254; 68%) included patients who had an early return to home and a mostly hospital-free trajectory for the year after ICU discharge. The participants were discharged home in 99.8% of cases for a median 338 (323-354) days. At 1 year, 98% were alive and 95% were at home.
Cluster 2 (n=13,775; 18%) included patients with more complex and heterogeneous pathways. Despite having more frequent rehospitalizations, 91% of the patients returned home for 242 (174-277) days. At 1 year after ICU discharge, 92% had survived and 70% were at home.
Cluster 3 (n=11,103; 14%) included patients who died in the year after ICU discharge. In this period, 37% returned home for a median of 45 (15-90) days with none at home at 1 year after ICU discharge. In this cluster, 44% of patients were re-hospitalized in an ACH for a median of 19 (8-37) days with a median of 2 (1-3) stays, 28% were admitted to rehabilitation facilities for 29 (14-55) days, and 11% had hospital-at-home care for 28 (11-67) days.
Study limitations include the observational design and the use of hospitalization data to define health care trajectories. In addition, clinical information, functional status, and markers of quality of life were not directly available in the SNDS, and hospital bed availability, regional resource differences, and health care provider preferences could have affected health care trajectories.
The investigators noted that “Recently, ability to return home and hospital free days have been proposed as significant patient-centered outcomes in ICU survivors. Implementing strategies to accelerate and improve recovery and the ability to return home are advocated by both critical illness survivors and clinicians.” The researchers said that their results indicated that “Most patients surviving a critical illness could return home,” even though many “had complex health care trajectories” in the year following their ICU discharge.
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Martin GL, Atramont A, Mazars M, et al. Days spent at home and mortality after critical illness: a cluster analysis using nationwide data. Chest. Published online October 15, 2022. doi:10.1016/j.chest.2022.10.008