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In-hospital vs. 30-day mortality in the critically ill - a 2-year Swedish intensive care cohort analysis
Akershus University Hospital, Norway.
Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
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2015 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 7, 846-858 p.Article in journal (Refereed) Published
Abstract [en]

Background

Standardised mortality ratio (SMR) is a common quality indicator in critical care and is the ratio between observed mortality and expected mortality.

Typically, in-hospital mortality is used to derive SMR, but the use of a time-fixed, more objective, end-point has been advocated. This study aimed to determine the relationship between in-hospital mortality and 30-day mortality on a comprehensive Swedish intensive care cohort.

Methods

A retrospective study on patients >15 years old, from the Swedish Intensive Care Register (SIR), where intensive care unit (ICU) admissions in 2009–2010 were matched with the corresponding hospital admissions in the Swedish Hospital Discharge Register. Recalibrated SAPS (Simplified Acute Physiology Score) 3 models were developed to predict and compare in-hospital and 30-day mortality. SMR based on in-hospital mortality and on 30-day mortality were compared between ICUs and between groups with different case-mixes, discharge destinations and length of hospital stays.

Results

Sixty-five ICUs with 48861 patients, of which 35610 were SAPS 3 scored, were included. Thirty-day mortality (17%) was higher than in-hospital mortality (14%). The SMR based on 30-day mortality and that based on in-hospital mortality differed significantly in 7/53 ICUs, for patients with sepsis, for elective surgery-admissions and in groups categorised according to discharge destination and hospital length of stay.

Conclusion

Choice of mortality end-point influences SMR. The extent of the influence depends on hospital-, ICU- and patient cohort characteristics as well as inter-hospital transfer rates, as all these factors influence the difference between SMR based on 30-day mortality and SMR based on in-hospital mortality.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015. Vol. 59, no 7, 846-858 p.
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-120439DOI: 10.1111/aas.12554ISI: 000357969800004PubMedID: 26041018OAI: oai:DiVA.org:liu-120439DiVA: diva2:845700
Available from: 2015-08-12 Created: 2015-08-11 Last updated: 2016-04-25Bibliographically approved

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Walther, StenSjöberg, Folke
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Department of Anaesthesiology and Intensive Care in NorrköpingDepartment of Anaesthesiology and Intensive Care in LinköpingDepartment of Medical and Health SciencesFaculty of Medicine and Health SciencesDepartment of Thoracic and Vascular SurgeryDivision of Cardiovascular MedicineDivision of Clinical SciencesDepartment of Hand and Plastic Surgery
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Acta Anaesthesiologica Scandinavica
Clinical Medicine

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