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Relationship Between ICU Length of Stay and Long-term
Mortality for Elderly ICU Survivors
Vivek K. Moitra, MD; Carmen Guerra, MPH; Walter T. Linde-Zwirble; and Hannah
Wunsch, MSc, MD
Critical Care Medicine
Media Originally for:
Critical Care Physicians, General Public, General Medical Professionals, Nurses and/or Other Critical Care Medical Professionals
Objective—To evaluate the association between length of ICU stay and 1-year mortality for elderly patients who survived to hospital discharge in the United States.
Design and Setting—Retrospective cohort study of a random sample of Medicare beneficiaries who survived to hospital discharge, with 1 and 3-year follow-up, stratified by the number of days of intensive care and with additional stratification based on receipt of mechanical ventilation.
Patients—The cohort included 34,696 Medicare beneficiaries older than 65 years who received intensive care and survived to hospital discharge in 2005.
Measurements and Main Results—Among 34,696 patients who survived to hospital
discharge, the mean ICU length of stay was 3.4 (±4.5) days. 88.9% of patients were in the ICU for 1–6 days, representing 58.6% of ICU bed-days. 1.3% of patients were in the ICU for 21+ days, but these patients used 11.6% of bed-days. The percentage of mechanically ventilated patients increased with increasing length of stay (6.3% for 1–6 days in the ICU and 71.3% for 21+ days). One-year mortality was 26.6%, ranging from 19.4% for patients in the ICU for one day, up to 57.8% for patients in the ICU for 21+ days. For each day beyond seven days in the ICU, there was an increased odds of death by 1-year of 1.04 (95% CI 1.03–1.05) irrespective of the need for mechanical ventilation.
Conclusions—Increasing ICU length of stay is associated with higher 1-year mortality for both mechanically ventilated and non-mechanically ventilated patients. No specific cut-off was associated with a clear plateau or sharp increase in long-term risk.
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