Tags

Type your tag names separated by a space and hit enter

Mortality and length-of-stay outcomes, 1993-2003, in the binational Australian and New Zealand intensive care adult patient database.
Crit Care Med 2008; 36(1):46-61CC

Abstract

OBJECTIVE

Intensive care unit (ICU) outcomes have been the subject of controversy. The objective was to model hospital mortality and ICU length-of-stay time-change of patients recorded in the Australian and New Zealand Intensive Care Society adult patient database.

DESIGN

Retrospective, cohort study of prospectively collected data on index patient admissions.

SETTING

Australian and New Zealand ICUs, 1993-2003.

PATIENTS

The Australian and New Zealand Intensive Care Society adult patient database, which contains data for 223,129 patients.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Hospital mortality and ICU length of stay were modeled using logistic and linear regression, respectively, with determination (80%) and validation (20%) data sets. Model adequacy was assessed by discrimination (receiver operating characteristic curve area, AZ) and calibration (Hosmer-Lemeshow C) for mortality and R2 for length of stay. Predictor variables included patient demographics, severity score, surgical and ventilation status, ICU categories, and geographical locality. The data set comprised 223,129 patients: Their mean (SD) age was 59.2 (18.9) yrs, 41.7% were female, their mean (SD) Acute Physiology and Chronic Health Evaluation (APACHE) III score was 53 (31), they had 16.1% overall mortality rate, and 45.7% were mechanically ventilated. ICU length of stay was 3.6 (5.6) days. A(Z), C statistic, and R2 for developmental and validation model data sets were 0.88, 17.64 (p = .02), and 0.18; and 0.88, 12.32 (p = .26), and 0.18, respectively. Variables with mortality impact (p < or = .001) were age (odds ratio [OR] 1.023), gender (OR 1.16; males vs. females), APACHE III score (OR 1.06), mechanical ventilation (OR 1.66), and surgical status (elective, OR 0.17; emergency, OR 0.47; compared with nonsurgical). ICU level and locality had significant mortality-time effects. Similar variables were found to predict length of stay. Risk-adjusted mortality declined, during 1993-2003, from 0.19 (95% confidence interval 0.17-0.21) to 0.15 (0.13-0.16) and similarly for ventilated patients: 0.26 (0.24-0.29) to 0.23 (0.21-0.25). Predicted mean ICU length of stay (days) demonstrated minimal overall time-change: 3.4 (2.2) in 1993 to 3.5 (2.7) in 2003, peaking at 3.7 (2.4) in 2000.

CONCLUSIONS

Overall hospital mortality rate in patients admitted to Australian and New Zealand ICUs decreased 4% over 11 yrs. A similar trend occurred for mechanically ventilated patients. Length of stay changed minimally over this period.

Authors+Show Affiliations

Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, SA, Australia. john.moran@nwahs.sa.gov.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18090383

Citation

Moran, John L., et al. "Mortality and Length-of-stay Outcomes, 1993-2003, in the Binational Australian and New Zealand Intensive Care Adult Patient Database." Critical Care Medicine, vol. 36, no. 1, 2008, pp. 46-61.
Moran JL, Bristow P, Solomon PJ, et al. Mortality and length-of-stay outcomes, 1993-2003, in the binational Australian and New Zealand intensive care adult patient database. Crit Care Med. 2008;36(1):46-61.
Moran, J. L., Bristow, P., Solomon, P. J., George, C., & Hart, G. K. (2008). Mortality and length-of-stay outcomes, 1993-2003, in the binational Australian and New Zealand intensive care adult patient database. Critical Care Medicine, 36(1), pp. 46-61.
Moran JL, et al. Mortality and Length-of-stay Outcomes, 1993-2003, in the Binational Australian and New Zealand Intensive Care Adult Patient Database. Crit Care Med. 2008;36(1):46-61. PubMed PMID: 18090383.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mortality and length-of-stay outcomes, 1993-2003, in the binational Australian and New Zealand intensive care adult patient database. AU - Moran,John L, AU - Bristow,Peter, AU - Solomon,Patricia J, AU - George,Carol, AU - Hart,Graeme K, AU - ,, PY - 2007/12/20/pubmed PY - 2008/2/13/medline PY - 2007/12/20/entrez SP - 46 EP - 61 JF - Critical care medicine JO - Crit. Care Med. VL - 36 IS - 1 N2 - OBJECTIVE: Intensive care unit (ICU) outcomes have been the subject of controversy. The objective was to model hospital mortality and ICU length-of-stay time-change of patients recorded in the Australian and New Zealand Intensive Care Society adult patient database. DESIGN: Retrospective, cohort study of prospectively collected data on index patient admissions. SETTING: Australian and New Zealand ICUs, 1993-2003. PATIENTS: The Australian and New Zealand Intensive Care Society adult patient database, which contains data for 223,129 patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Hospital mortality and ICU length of stay were modeled using logistic and linear regression, respectively, with determination (80%) and validation (20%) data sets. Model adequacy was assessed by discrimination (receiver operating characteristic curve area, AZ) and calibration (Hosmer-Lemeshow C) for mortality and R2 for length of stay. Predictor variables included patient demographics, severity score, surgical and ventilation status, ICU categories, and geographical locality. The data set comprised 223,129 patients: Their mean (SD) age was 59.2 (18.9) yrs, 41.7% were female, their mean (SD) Acute Physiology and Chronic Health Evaluation (APACHE) III score was 53 (31), they had 16.1% overall mortality rate, and 45.7% were mechanically ventilated. ICU length of stay was 3.6 (5.6) days. A(Z), C statistic, and R2 for developmental and validation model data sets were 0.88, 17.64 (p = .02), and 0.18; and 0.88, 12.32 (p = .26), and 0.18, respectively. Variables with mortality impact (p < or = .001) were age (odds ratio [OR] 1.023), gender (OR 1.16; males vs. females), APACHE III score (OR 1.06), mechanical ventilation (OR 1.66), and surgical status (elective, OR 0.17; emergency, OR 0.47; compared with nonsurgical). ICU level and locality had significant mortality-time effects. Similar variables were found to predict length of stay. Risk-adjusted mortality declined, during 1993-2003, from 0.19 (95% confidence interval 0.17-0.21) to 0.15 (0.13-0.16) and similarly for ventilated patients: 0.26 (0.24-0.29) to 0.23 (0.21-0.25). Predicted mean ICU length of stay (days) demonstrated minimal overall time-change: 3.4 (2.2) in 1993 to 3.5 (2.7) in 2003, peaking at 3.7 (2.4) in 2000. CONCLUSIONS: Overall hospital mortality rate in patients admitted to Australian and New Zealand ICUs decreased 4% over 11 yrs. A similar trend occurred for mechanically ventilated patients. Length of stay changed minimally over this period. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/18090383/Mortality_and_length_of_stay_outcomes_1993_2003_in_the_binational_Australian_and_New_Zealand_intensive_care_adult_patient_database_ L2 - http://Insights.ovid.com/pubmed?pmid=18090383 DB - PRIME DP - Unbound Medicine ER -