In-hospital vs. 30-day mortality in the critically ill - a 2-year Swedish intensive care cohort analysis
(2015) In Acta Anaesthesiologica Scandinavica 59(7). p.846-858- Abstract
- BackgroundStandardised mortality ratio (SMR) is a common quality indicator in critical care and is the ratio between observed mortality and expected mortality. Typically, in-hospital mortality is used to derive SMR, but the use of a time-fixed, more objective, end-point has been advocated. This study aimed to determine the relationship between in-hospital mortality and 30-day mortality on a comprehensive Swedish intensive care cohort. MethodsA retrospective study on patients >15years old, from the Swedish Intensive Care Register (SIR), where intensive care unit (ICU) admissions in 2009-2010 were matched with the corresponding hospital admissions in the Swedish Hospital Discharge Register. Recalibrated SAPS (Simplified Acute Physiology... (More)
- BackgroundStandardised mortality ratio (SMR) is a common quality indicator in critical care and is the ratio between observed mortality and expected mortality. Typically, in-hospital mortality is used to derive SMR, but the use of a time-fixed, more objective, end-point has been advocated. This study aimed to determine the relationship between in-hospital mortality and 30-day mortality on a comprehensive Swedish intensive care cohort. MethodsA retrospective study on patients >15years old, from the Swedish Intensive Care Register (SIR), where intensive care unit (ICU) admissions in 2009-2010 were matched with the corresponding hospital admissions in the Swedish Hospital Discharge Register. Recalibrated SAPS (Simplified Acute Physiology Score) 3 models were developed to predict and compare in-hospital and 30-day mortality. SMR based on in-hospital mortality and on 30-day mortality were compared between ICUs and between groups with different case-mixes, discharge destinations and length of hospital stays. ResultsSixty-five ICUs with 48861 patients, of which 35610 were SAPS 3 scored, were included. Thirty-day mortality (17%) was higher than in-hospital mortality (14%). The SMR based on 30-day mortality and that based on in-hospital mortality differed significantly in 7/53 ICUs, for patients with sepsis, for elective surgery-admissions and in groups categorised according to discharge destination and hospital length of stay. ConclusionChoice of mortality end-point influences SMR. The extent of the influence depends on hospital-, ICU- and patient cohort characteristics as well as inter-hospital transfer rates, as all these factors influence the difference between SMR based on 30-day mortality and SMR based on in-hospital mortality. (Less)
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https://lup.lub.lu.se/record/7779708
- author
- Rydenfelt, K. ; Engerstrom, L. ; Walther, S. ; Sjoberg, F. ; Stromberg, U. and Samuelsson, Carolina LU
- organization
- publishing date
- 2015
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Acta Anaesthesiologica Scandinavica
- volume
- 59
- issue
- 7
- pages
- 846 - 858
- publisher
- Wiley-Blackwell
- external identifiers
-
- wos:000357969800004
- scopus:84937022909
- pmid:26041018
- ISSN
- 0001-5172
- DOI
- 10.1111/aas.12554
- language
- English
- LU publication?
- yes
- id
- 466b29a2-df8f-4ad4-bca9-a83eb6161d03 (old id 7779708)
- date added to LUP
- 2016-04-01 10:54:43
- date last changed
- 2022-03-04 23:58:11
@article{466b29a2-df8f-4ad4-bca9-a83eb6161d03, abstract = {{BackgroundStandardised mortality ratio (SMR) is a common quality indicator in critical care and is the ratio between observed mortality and expected mortality. Typically, in-hospital mortality is used to derive SMR, but the use of a time-fixed, more objective, end-point has been advocated. This study aimed to determine the relationship between in-hospital mortality and 30-day mortality on a comprehensive Swedish intensive care cohort. MethodsA retrospective study on patients >15years old, from the Swedish Intensive Care Register (SIR), where intensive care unit (ICU) admissions in 2009-2010 were matched with the corresponding hospital admissions in the Swedish Hospital Discharge Register. Recalibrated SAPS (Simplified Acute Physiology Score) 3 models were developed to predict and compare in-hospital and 30-day mortality. SMR based on in-hospital mortality and on 30-day mortality were compared between ICUs and between groups with different case-mixes, discharge destinations and length of hospital stays. ResultsSixty-five ICUs with 48861 patients, of which 35610 were SAPS 3 scored, were included. Thirty-day mortality (17%) was higher than in-hospital mortality (14%). The SMR based on 30-day mortality and that based on in-hospital mortality differed significantly in 7/53 ICUs, for patients with sepsis, for elective surgery-admissions and in groups categorised according to discharge destination and hospital length of stay. ConclusionChoice of mortality end-point influences SMR. The extent of the influence depends on hospital-, ICU- and patient cohort characteristics as well as inter-hospital transfer rates, as all these factors influence the difference between SMR based on 30-day mortality and SMR based on in-hospital mortality.}}, author = {{Rydenfelt, K. and Engerstrom, L. and Walther, S. and Sjoberg, F. and Stromberg, U. and Samuelsson, Carolina}}, issn = {{0001-5172}}, language = {{eng}}, number = {{7}}, pages = {{846--858}}, publisher = {{Wiley-Blackwell}}, series = {{Acta Anaesthesiologica Scandinavica}}, title = {{In-hospital vs. 30-day mortality in the critically ill - a 2-year Swedish intensive care cohort analysis}}, url = {{http://dx.doi.org/10.1111/aas.12554}}, doi = {{10.1111/aas.12554}}, volume = {{59}}, year = {{2015}}, }