Association of intensive care unit occupancy during admission and inpatient mortality: a retrospective cohort study
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REPORTS OF ORIGINAL INVESTIGATIONS
Association of intensive care unit occupancy during admission and inpatient mortality: a retrospective cohort study Association entre le taux d’occupation a` l’unite´ de soins intensifs pendant l’admission et la mortalite´ hospitalie`re: une e´tude de cohorte re´trospective Nicholas A. Fergusson, MSc . Steve Ahkioon, PhD . Mahesh Nagarajan, PhD . Eric Park, PhD . Yichuan Ding, PhD . Najib Ayas, MD . Vinay K. Dhingra, MD . Dean R. Chittock, MD . Donald E. G. Griesdale, MD Received: 17 April 2019 / Revised: 17 June 2019 / Accepted: 17 June 2019 Ó Canadian Anesthesiologists’ Society 2019
Abstract Purpose There is conflicting evidence regarding the influence of intensive care unit (ICU) occupancy at the time of admission on important patient outcomes such as mortality. The objective of this analysis was to characterize the association between ICU occupancy at the time of ICU admission and subsequent mortality. Methods This single-centre, retrospective cohort study included all patients admitted to the ICU at the Vancouver General Hospital between 4 January 2010 and 8 October 2017. Intensive care unit occupancy was defined as the number of ICU bed hours utilized in a day divided by the total amount of ICU bed hours available for that day. We
constructed mixed-effects logistic regression models controlling for relevant covariates to assess the impact of admission occupancy quintiles on total inpatient (ICU and ward) and early (72-hr) ICU mortality. Results This analysis included 10,365 ICU admissions by 8,562 unique patients. Compared with ICU admissions in the median occupancy quintile, admissions in the highest and second highest occupancy quintile were associated with a significant increase in the odds of inpatient mortality (highest: odds ratio [OR], 1.33; 95% confidence interval [CI], 1.12 to 1.59; P value \ 0.001; second highest: OR, 1.21; 95% CI, 1.02 to 1.44; P value \ 0.03). No association between admission occupancy and 72-hr ICU mortality was observed.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-019-01476-8) contains supplementary material, which is available to authorized users. N. A. Fergusson, MSc University of British Columbia, Vancouver, BC, Canada S. Ahkioon, PhD Vancouver Coastal Health, Vancouver, BC, Canada M. Nagarajan, PhD Y. Ding, PhD Sauder School of Business, University of British Columbia, Vancouver, BC, Canada E. Park, PhD Faculty of Business and Economics, University of Hong Kong, Pokfulam, Hong Kong
D. E. G. Griesdale, MD (&) Department of Anesthesiology, Pharmacology, Therapeutics, University of British Columbia, Vancouver, BC, Canada e-mail: [email protected] Department of Medicine, Divisions of Critical Care Medicine and Neurology, University of British Columbia, Vancouver, BC, Canada Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
N. Ayas, MD V. K. Dhingra, MD D. R. Chittock, MD Division of Critical Care Medicine,
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