Hospital re-admission after critical care survival: a systematic review and meta-analysis (original) (raw)

McPeake, J. ORCID: https://orcid.org/0000-0001-8206-6801, Bateson, M., Christie, F., Robinson, C., Cannon, P. ORCID: https://orcid.org/0000-0001-8721-1481, Mikkelsen, M., Iwashyna, T.J., Leyland, A.H. ORCID: https://orcid.org/0000-0003-3741-7099, Shaw, M. and Quasim, T. ORCID: https://orcid.org/0000-0002-9872-3623(2022) Hospital re-admission after critical care survival: a systematic review and meta-analysis.Anaesthesia, 77(4), pp. 475-485. (doi: 10.1111/anae.15644) (PMID:34967011)

Abstract

Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta-analysis to assess hospital re-admission rates following critical care admission and to explore potential re-admission risk factors. We searched the MEDLINE, Embase and CINAHL databases on 05 March 2020. Our search strategy incorporated controlled vocabulary and text words for hospital re-admission and critical illness, limited to English language. Two reviewers independently applied pre-defined eligibility criteria and assessed quality using the Newcastle Ottawa Score checklist and extracted data. Primary outcome was acute hospital re-admission in the year after critical care discharge. Of the 8851 studies screened, 87 met inclusion criteria and 41 were used within the meta-analysis. The analysis incorporated data from 3,897,597 individual patients and 741,664 re-admission episodes. Pooled estimates for hospital re-admission after critical illness were 16.9% (95%CI: 13.3–21.2%) at 30 days; 31.0% (95%CI: 24.3–38.6%) at 90 days; 29.6% (95%CI: 24.5–35.2%) at six months; and 53.3% (95%CI: 44.4–62.0%) at 12 months. Significant heterogeneity was observed across included studies. Three risk factor contributed to excess acute care rehospitalisation one year after discharge: the presence of comorbidities; events during initial hospitalisation (e.g. the presence of delirium and duration of mechanical ventilation); and subsequent infection during the post-hospital discharge period. Hospital re-admission is common in survivors of critical illness. Careful attention to the management of pre-existing comorbidities during transitions of care may help reduce healthcare utilisation after critical care discharge. Future research should determine if targeted interventions for at-risk critical care survivors can reduce the risk of subsequent rehospitalisation.

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Funder and Project Information

1

Measuring and Analysing Socioeconomic Inequalities in Health

Alastair Leyland

MC_UU_12017/13

HW - MRC/CSO Social and Public Health Sciences Unit

1

Measuring and Analysing Socioeconomic Inequalities in Health

Alastair Leyland

SPHSU13

HW - MRC/CSO Social and Public Health Sciences Unit

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