Martin, Guillaume L;
Atramont, Alice;
Mazars, Marjorie;
Tajahmady, Ayden;
Agamaliyev, Emin;
Singer, Mervyn;
Leone, Marc;
(2022)
Days Spent at Home and Mortality After Critical Illness: A Cluster Analysis Using Nationwide Data.
Chest
10.1016/j.chest.2022.10.008.
(In press).
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Abstract
BACKGROUND: Beyond the question of short-term survival, days spent at home could be considered a patient-centered outcome in critical care trials. RESEARCH QUESTION: What are the days spent at home and healthcare trajectories during the year after surviving critical illness? STUDY DESIGN AND METHODS: Data were extracted on adult survivors spending at least two nights in a French intensive care unit (ICU) during 2018 who were treated with invasive mechanical ventilation and/or vasopressors or inotropes. Trauma, burn, organ transplant, stroke and neurosurgical patients were excluded. Stays at home, death, hospitalizations were reported before and after ICU stay, using state sequence analysis. An unsupervised clustering method was performed to identify cohorts based on post-ICU trajectories. RESULTS: Of 77,132 ICU survivors, 89% returned home. In the year post-discharge, these patients spent a median 330 (IQR 283-349) days at home. At one year, 77% of patients were still at home and 17% had died. Fifty-one percent had been re-hospitalized and 10% required a further ICU admission. Forty-eight percent used rehabilitation facilities and 5.7% hospital at home. Three clusters of patients with distinct post-ICU trajectories were identified. Patients in cluster 1 (68% of total) survived and spent most of the year at home (338 (323-354) days). Patients in cluster 2 (18%) had more complex trajectories but most could return home (91%), spending 242 (174-277) days at home. Patients in cluster 3 (14%) died with only 37% returning home for 45 (15-90) days. INTERPRETATION: Many patients had complex healthcare trajectories after surviving critical illness. Wide variations in the ability to return home after ICU discharge was observed between clusters, which represents an important patient-centered outcome.
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| 2. |  Indonesia | 1 |
| 3. |  Iran, Islamic Republic of | 1 |
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