Open AccessAssociation between pre-intensive care unit (ICU) hospital length of stay and ICU outcomes in a resource- limited setting
Author(s) -
Sadia Khan,
AUTHOR_ID,
Robert Wise,
Sugeevan Savarimuthu,
George L. Anesi
Publication year - 2021
Publication title -
southern african journal of critical care/the southern african journal of critical care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.129
H-Index - 7
eISSN - 2078-676X
pISSN - 1562-8264
DOI - 10.7196/sajcc.2021.v37i3.500
Subject(s) - medicine , interquartile range , intensive care unit , logistic regression , emergency medicine , confidence interval , odds ratio , hazard ratio , retrospective cohort study , intensive care , intensive care medicine
Background. Previous studies demonstrated higher mortality for patients with a longer pre-intensive care unit (ICU) hospital length of stay (LOS), in well-resourced settings. Objectives. The study aimed to determine the association between pre-ICU hospital LOS and ICU outcomes in a resource-limited setting. We hypothesised that longer pre-ICU hospital LOS would be associated with higher ICU mortality. Methods. This was a retrospective cohort study measuring the association between pre-ICU hospital LOS and ICU outcomes using data extracted from a regional hospital ICU in KwaZulu-Natal, South Africa. Consecutive ICU admissions of all patients (medical and surgical) older than 18 years were included during the study period September 2014 to August 2018. A corrected sample size of 2 040 patients was identified. Multivariable logistic regression was used to assess the primary outcome of ICU mortality, and multivariable Cox proportional hazard regression was used for the secondary outcome of ICU LOS. Results. The median pre-ICU hospital LOS was 1 day (interquartile range (IQR) 0 - 2 days). The median length of ICU stay was 2.4 days (IQR 1.1 - 4.8 days) and the observed ICU mortality was 16% (n=327/2 040). Pre-ICU hospital LOS was not associated with ICU mortality in the unadjusted (odds ratio (OR) 1.00; 95% confidence interval (CI) 0.98 - 1.02; p=0.68; n=2 040) and fully adjusted logistic regression models (OR 1.00; 95% CI 0.98 - 1.03; p=0.90; n=1 981) using a complete case analysis for missing patient-level covariates. In Cox proportional hazard models, there was no association between pre-ICU hospital LOS and ICU LOS (hazard ratio 1.00; 95% CI 0.98 - 1.03; p=0.72; n=1 967), including when stratified by admission source. Conclusions. Pre-ICU hospital LOS was not associated with either ICU mortality or ICU LOS in a resource-limited setting. Future studies should aim to include multicentre data and evaluate long-term outcomes.