Nature and impact of in-hospital complications associated with persistent critical illness

Boris Tseitkin; Johan Mårtensson; Glenn M Eastwood; Alastair Brown; Paolo Ancona; Luca Lucchetta; Theodore J Iwashyna; Raymond Robbins; Rinaldo Bellomo

doi:10.51893/2020.4.OA11

Nature and impact of in-hospital complications associated with persistent critical illness

Crit Care Resusc. 2023 Oct 18;22(4):378-387. doi: 10.51893/2020.4.OA11. eCollection 2020 Dec.

Authors

Boris Tseitkin¹, Johan Mårtensson^{1

2}, Glenn M Eastwood^{1

3}, Alastair Brown¹, Paolo Ancona^{1

4}, Luca Lucchetta^{1

5}, Theodore J Iwashyna^{6

7}, Raymond Robbins⁸, Rinaldo Bellomo^{1

3

9

10

11}

Affiliations

¹ Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
² Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
³ Australian and New Zealand Intensive Care Society Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁴ Department of Intensive Care Medicine, Catholic University of the Sacred Heart, "A. Gemelli" University Hospital, Rome, Italy.
⁵ Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁶ Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
⁷ Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
⁸ Department of Administrative Informatics, Austin Hospital, Melbourne, VIC, Australia.
⁹ School of Medicine, University of Melbourne, Melbourne, VIC, Australia.
¹⁰ Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital and University of Melbourne, Melbourne, VIC, Australia.
¹¹ Department of Intensive Care, Royal Melbourne Hospital, VIC, Australia.

Abstract

Background: Persistent critical illness (PerCI) is defined as an intensive care unit (ICU) admission lasting ≥ 10 days. The in-hospital complications associated with its development are poorly understood. Aims: To test whether PerCI is associated with a greater prevalence, rate and specific types of in-hospital complications. Methods: Single-centre, retrospective, observational case-control study. Results: We studied 1200 patients admitted to a tertiary ICU from 2010 to 2015. Median ICU length of stay was 16 days (interquartile range [IQR], 12-23) for PerCI patients v 2.3 days (IQR, 1.1-3.7) for controls, and median hospital length of stay was 41 days (IQR, 22-75) v 8 days (IQR, 4-17) respectively. A greater proportion of PerCI patients received acute renal replacement therapy (37% v 6.8%) or underwent reintubation (17% v 1%) and/or tracheostomy (36% v 0.6%); P < 0.0001. Despite these complications, PerCI patients had similar hospital mortality (29% v 27%; P = 0.53). PerCI patients experienced a greater absolute number of complications (12.1 v 4.0 complications per patient; P < 0.0001) but had fewer exposure-adjusted complications (202 v 272 complications per 1000 hospital bed-days; P < 0.001) and a particularly high overall prevalence of specific complications. Conclusions: PerCI patients experience a higher prevalence, but not a higher rate, of exposure-adjusted complications. Some of these complications appear amenable to prevention, helping to define intervention targets in patients at risk of PerCI. Funding: Austin Hospital Intensive Care Trust Fund.