• Anssi Pölkki, André Moser, Rahul Raj, Jukka Takala, Stepani Bendel, Stephan M Jakob, and Matti Reinikainen.
• Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland.
• Crit. Care Med. 2024 Mar 1; 52 (3): 387395387-395.

ObjectivesThe standardized mortality ratio (SMR) is a common metric to benchmark ICUs. However, SMR may be artificially distorted by the admission of potential organ donors (POD), who have nearly 100% mortality, although risk prediction models may not identify them as high-risk patients. We aimed to evaluate the impact of PODs on SMR.DesignRetrospective registry-based multicenter study.SettingTwenty ICUs in Finland, Estonia, and Switzerland in 2015-2017.PatientsSixty thousand forty-seven ICU patients.InterventionsNone.Measurements And Main ResultsWe used a previously validated mortality risk model to calculate the SMRs. We investigated the impact of PODs on the overall SMR, individual ICU SMR and ICU benchmarking. Of the 60,047 patients admitted to the ICUs, 514 (0.9%) were PODs, and 477 (93%) of them died. POD deaths accounted for 7% of the total 6738 in-hospital deaths. POD admission rates varied from 0.5 to 18.3 per 1000 admissions across ICUs. The risk prediction model predicted a 39% in-hospital mortality for PODs, but the observed mortality was 93%. The ratio of the SMR of the cohort without PODs to the SMR of the cohort with PODs was 0.96 (95% CI, 0.93-0.99). Benchmarking results changed in 70% of ICUs after excluding PODs.ConclusionsDespite their relatively small overall number, PODs make up a large proportion of ICU patients who die. PODs cause bias in SMRs and in ICU benchmarking. We suggest excluding PODs when benchmarking ICUs with SMR.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.

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