Definition, risk factors and outcome of prolonged surgical intensive care unit stay

Abstract

There is no generally accepted definition for a "prolonged surgical intensive care unit (SICU) stay". The aims of the current study were to: 1) define prolonged SICU stay; 2) identify risk factors of prolonged SICU stay; and 3) identify risk factors of hospital mortality in patients with a prolonged SICU stay. All SICU patients aged >16 years and with an intensive care unit (ICU) stay longer than three days without ICU readmission between 1 January 2004 and 30 November 2006 at the National Taiwan University Hospital were recruited to the study. A total of 2598 patients were recruited. ICU stay >16 days was defined as a prolonged SICU stay since rates of ICU mortality, hospital mortality and mortality one year after ICU discharge remained stationary after ICU stay was >16 days. A multivariate logistic regression model identified factors associated with a prolonged SICU stay, including age more than 70 years old, (odds ratio 1.587, 95% confidence interval 1.246 to 2.022), increasing pre-ICU hospital days (odds ratio 1.009, 95% confidence interval 1.003 to 1.015), admission from emergency (odds ratio 1.925, 95% confidence interval 1.455 to 2.548), use of mechanical circulation support (odds ratio 2.314, 95% confidence interval 1.458 to 3.674) and renal replacement therapy (odds ratio 5.140, 95% confidence interval 3.781 to 6.987). A multivariate logistic regression model identified factors associated with ICU mortality in patients with ICU stay >16 days, including renal replacement therapy (odds ratio 4.780, 95% confidence interval 2.687 to 8.504). An ICU stay >16 days could be used to define prolonged SICU stay when hospital and one-year mortality rates are considered. Prevention of organ failure requiring renal replacement therapy might prove a useful goal to avoid prolonged ICU stay and even hospital mortality.