Long-term admission to the intensive care unit: a cost-benefit analysis / Ingresos de larga duración en la unidad de cuidados intensivos: análisis de costo-beneficio

Objective. To assess outcomes in long-term ICU patients, with follow-ups carried out at one year post discharge, in order to calculate the costs incurred by the hospital in relation to the benefits gained. Material. Of 3639 patients consecutively admitted over the course of three years to ICU, 235 (6.5%) were assessed for the purposes of the study, having spent a period exceeding 20 days in intensive care. Method. The survey tool used was the Spanish Minimum Data Set (MDS). The length of ICU stay and hospital stay following discharge from ICU were calculated, and one year post discharge the patient/next of kin was contacted in order to carry out a follow-up survey on survival and functional status (according to GOS-E scale). Results. The 235 study patients had a mean stay of 37 days, occupied 34% of ICU beds available and consumed 29% of the ICU's economic resources ($14,400,175). Their stay on hospital wards was (mean) 33 days. Mortality in ICU and on hospital wards was 40% higher amongst older patients, and those with a higher APACHE II and Charlson index score. Mortality rates were three times higher among neurosurgical patients: mortality at follow-up was 25%, and only 21% recovered an acceptable functional status. Conclusions. Mortality rates in long-term ICU patients are high, both during their hospital stay and in the first year post discharge. Surviving patients (AU)

Objetivo. Evaluar los resultados de los pacientes de larga duración en la UCI por medio de un seguimiento al año del alta a fin de calcular los gastos soportados por el hospital en relación con los beneficios obtenidos. Materiales. de los 3.639 pacientes consecutivos ingresados en la UCI durante tres años, se evaluó a 235 (un 6,5%) para el presente estudio, todos ellos con una estancia superior a 20 días. Métodos. el instrumento de evaluación fue la base de datos española CMBD (conjunto mínimo de base de datos). Se calcularon la duración de la estancia en la UCI y en la planta después del alta de la UCI y, un año después del alta hospitalaria, se contactó con el paciente o su pariente más próximo para realizar una encuesta de seguimiento sobre su estado funcional (según la escala GOSE). Resultados. los 235 pacientes estudiados estuvieron ingresados un promedio de 37 días, ocuparon un 34% de las camas disponibles en la UCI y emplearon un 29% de los recursos económicos de dicha unidad (14.400.175$). Su estancia media en planta fue de 33 días. La mortalidad en la UCI y en planta fue un 40% más alta en los pacientes de mayor edad, puntuación del APACHE II e índice de Charlson. Las tasas de mortalidad se triplicaron en los pacientes neuroquirúrgicos. En el seguimiento después de un año, la tasa de mortalidad fue del 25%, y únicamente el 21% recuperó un estado funcional aceptable. Conclusiones. las tasas de mortalidad en pacientes de larga duración en la UCI son altas, tanto durante la estancia hospitalaria como durante el año posterior al alta. Los pacientes de larga duración no presentan una recuperación correcta y consumen una gran proporción de recursos económicos (AU)

Long-term admission to the intensive care unit: a cost-benefit analysis.

OBJECTIVE: To assess outcomes in long-term ICU patients, with follow-ups carried out at one year post discharge, in order to calculate the costs incurred by the hospital in relation to the benefits gained. MATERIAL: Of 3639 patients consecutively admitted over the course of three years to ICU, 235 (6.5%) were assessed for the purposes of the study, having spent a period exceeding 20 days in intensive care. METHOD: The survey tool used was the Spanish Minimum Data Set (MDS). The length of ICU stay and hospital stay following discharge from ICU were calculated, and one year post discharge the patient/next of kin was contacted in order to carry out a follow-up survey on survival and functional status (according to GOS-E scale). RESULTS: The 235 study patients had a mean stay of 37 days, occupied 34% of ICU beds available and consumed 29% of the ICU's economic resources ($14,400,175). Their stay on hospital wards was (mean) 33 days. Mortality in ICU and on hospital wards was 40% higher amongst older patients, and those with a higher APACHE II and Charlson index score. Mortality rates were three times higher among neurosurgical patients: mortality at follow-up was 25%, and only 21% recovered an acceptable functional status. CONCLUSIONS: Mortality rates in long-term ICU patients are high, both during their hospital stay and in the first year post discharge. Surviving patients do not exhibit a good level of recovery, and consume a large proportion of economic resources.