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In-hospital vs. 30-day mortality in the critically ill - a 2-year Swedish intensive care cohort analysis

Rydenfelt, K.; Engerstrom, L.; Walther, S.; Sjoberg, F.; Stromberg, U. and Samuelsson, Carolina LU (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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author
organization
publishing date
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
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
2015-09-01 16:05:37
date last changed
2017-03-26 03:19:13
@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},
  volume       = {59},
  year         = {2015},
}