Objective: To examine the association between ICU readmission rates and case-mix-adjusted outcomes.
Design: Retrospective cohort study of ICU admissions from 2002 to 2010.
Setting: One hundred five ICUs at 46 United States hospitals.
Patients: Of 369,129 admissions, 263,082 were first admissions that were alive at ICU discharge and candidates for readmission.
Measurements and main results: The median unit readmission rate was 5.9% (intraquartile range 5.1%-7.0%). Across all admissions, hospital mortality for patients with and without readmission was 21.3% vs. 3.6%, mean ICU stay 4.9 days vs. 3.4 days, and hospital stay 13.3 days vs. 4.5 days, respectively. We stratified ICUs according to their readmission rate: high (>7%), moderate (5%-7%), and low (<5%) rates. Observed and case-mix-adjusted hospital mortality, ICU and hospital lengths of stay were examined by readmission rate strata. Observed outcomes were much worse in the high readmission rate units. But after adjusting for patient and institutional differences, there was no association between level of unit readmission rate and case-mix-adjusted mortality. The difference between observed and predicted mortality was -0.4%, 0.4%, and -1.1%, for the high, medium, and low readmission rate strata, respectively. Additionally, the difference between observed and expected ICU length of stay was approximately zero for the three strata.
Conclusions: Patients readmitted to ICUs have increased hospital mortality and lengths of stay. After case-mix adjustment, there were no significant differences in standardized mortality or case-mix-adjusted lengths of stay between units with high readmission rates compared to units with moderate or low rates. The use of readmission as a quality measure should only be implemented if patient case-mix is taken into account.