• Allan Garland, Kendiss Olafson, Clare D Ramsey, Marina Yogendran, and Randall Fransoo.
• University of Manitoba, Medicine , 820 Sherbrook St. , GF-222 , Winnipeg, Manitoba, Canada , R3R 0A1 , 204-787-1198 ; agarland@hsc.mb.ca.
• Ann Am Thorac Soc. 2014 Dec 18.

AbstractRationale: Many studies of critical illness outcomes have been restricted to short-term outcomes, selected diagnoses, and patients in one or a few Intensive Care Units (ICUs). Objective: Evaluate a range of relevant outcomes in a population-based cohort of patients admitted to ICUs. Methods: Among all adult residents of the Canadian province of Manitoba admitted to ICUs over a nine year period we assessed ICU, hospital, 30 day and 180 day mortality rates; ICU and hospital lengths-of-stay; post-hospital utilization of hospital care, ICU care, outpatient physician care, medications, and home care; and post-hospital residence location. We explored data stratified by age, sex, and separate categories of geocoded income for urban and rural residents. For post-hospital utilization variables we compared ICU patients with those admitted to hospitals without the need for ICU care. Measurements and Main Results: After ICU admission there was a high initial death rate, which declined between 30 and 180 days and thereafter remained at the lower value. Hospital mortality was 19.0%, with 21.7% dying within six months of ICU admission. Women had higher hospital mortality than men (20.8 vs. 17.8%; p=0.0008). Among urban residents there was a steady gradient of declining hospital mortality with rising income (p<0.0001). Mean ICU length of stay was 3.96 days, increasing 0.11 days/year over the study period (p=0.001); median ICU length of stay was 2.33 days and did not change over time. In the year after ICU care, 41% were re-hospitalized, 10% were readmitted to an ICU, 98% had outpatient physician visits, 96% used prescription medications, and 27% used home care services. While most of these parameters were statistically higher than for hospitalizations not requiring ICU care, differences were generally small. Among hospital survivors, 2.7% were discharged to chronic care facilities, with 2.5% living in such facilities three months later. Conclusions: Post-hospital medical resource use among ICU survivors is substantial, though similar to that after non-ICU hospitalization. While the fraction of survivors unable to live independently was small, a larger fraction required home care services. Identifying post-hospital supports needed by ICU survivors can be useful for policy-makers and others responsible for healthcare planning.

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