Hospital readmission after critical care survival: a systematic review and meta-analysis

Joanne M. McPeake*, Meghan Bateson, Fiona Christie, Carly Robinson, Paul Cannon, Mark Mikkelsen, Theodore Iwashyna, Alastair Leyland, Martin Shaw, Tara Quasim

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta-analysis to assess hospital re-admission rates following critical care admission and to explore potential re-admission risk factors. We searched the MEDLINE, Embase and CINAHL databases on 05 March 2020. Our search strategy incorporated controlled vocabulary and text words for hospital re-admission and critical illness, limited to English language. Two reviewers independently applied pre-defined eligibility criteria and assessed quality using the Newcastle Ottawa Score checklist and extracted data. Primary outcome was acute hospital re-admission in the year after critical care discharge. Of the 8851 studies screened, 87 met inclusion criteria and 41 were used within the meta-analysis. The analysis incorporated data from 3,897,597 individual patients and 741,664 re-admission episodes. Pooled estimates for hospital re-admission after critical illness were 16.9% (95%CI: 13.3–21.2%) at 30 days; 31.0% (95%CI: 24.3–38.6%) at 90 days; 29.6% (95%CI: 24.5–35.2%) at six months; and 53.3% (95%CI: 44.4–62.0%) at 12 months. Significant heterogeneity was observed across included studies. Three risk factor contributed to excess acute care rehospitalisation one year after discharge: the presence of comorbidities; events during initial hospitalisation (e.g. the presence of delirium and duration of mechanical ventilation); and subsequent infection during the post-hospital discharge period. Hospital re-admission is common in survivors of critical illness. Careful attention to the management of pre-existing comorbidities during transitions of care may help reduce healthcare utilisation after critical care discharge. Future research should determine if targeted interventions for at-risk critical care survivors can reduce the risk of subsequent rehospitalisation.

Original languageEnglish
Number of pages11
JournalAnaesthesia
Early online date29 Dec 2021
DOIs
Publication statusE-pub ahead of print - 29 Dec 2021

Keywords

  • critical care
  • readmission
  • healthcare utilisation
  • prolonged critical illness

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