K Rydenfelt1, L Engerström2,3,4, S Walther3,4, F Sjöberg5,6, U Strömberg7, C Samuelsson8,9. 1. Department of Anaesthesiology and Intensive Care, Akershus University Hospital, Lørenskog, Norway. 2. Department of Anaesthesiology and Intensive Care, Vrinnevi Hospital, Norrköping, Sweden. 3. Department of Cardiothoracic Anaesthesia and Intensive Care, Linköping University Hospital, Linköping, Sweden. 4. Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden. 5. Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden. 6. The Burn Centre, Department of Hand, Plastic Surgery and Intensive Care, Linköping County Council, Linköping, Sweden. 7. Department of Research, Development and Education, Halland Hospital, Halmstad, Sweden. 8. Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö/Lund, Sweden. 9. Department of Anesthesiology and Intensive Care, Halland Hospital, Halmstad, Sweden.
Abstract
BACKGROUND: Standardised mortality ratio (SMR) is a common quality indicator in critical care and is the ratio between observed mortality and expected mortality. Typically, in-hospital mortality is used to derive SMR, but the use of a time-fixed, more objective, end-point has been advocated. This study aimed to determine the relationship between in-hospital mortality and 30-day mortality on a comprehensive Swedish intensive care cohort. METHODS: A retrospective study on patients >15 years old, from the Swedish Intensive Care Register (SIR), where intensive care unit (ICU) admissions in 2009-2010 were matched with the corresponding hospital admissions in the Swedish Hospital Discharge Register. Recalibrated SAPS (Simplified Acute Physiology Score) 3 models were developed to predict and compare in-hospital and 30-day mortality. SMR based on in-hospital mortality and on 30-day mortality were compared between ICUs and between groups with different case-mixes, discharge destinations and length of hospital stays. RESULTS: Sixty-five ICUs with 48861 patients, of which 35610 were SAPS 3 scored, were included. Thirty-day mortality (17%) was higher than in-hospital mortality (14%). The SMR based on 30-day mortality and that based on in-hospital mortality differed significantly in 7/53 ICUs, for patients with sepsis, for elective surgery-admissions and in groups categorised according to discharge destination and hospital length of stay. CONCLUSION: Choice of mortality end-point influences SMR. The extent of the influence depends on hospital-, ICU- and patient cohort characteristics as well as inter-hospital transfer rates, as all these factors influence the difference between SMR based on 30-day mortality and SMR based on in-hospital mortality.
BACKGROUND: Standardised mortality ratio (SMR) is a common quality indicator in critical care and is the ratio between observed mortality and expected mortality. Typically, in-hospital mortality is used to derive SMR, but the use of a time-fixed, more objective, end-point has been advocated. This study aimed to determine the relationship between in-hospital mortality and 30-day mortality on a comprehensive Swedish intensive care cohort. METHODS: A retrospective study on patients >15 years old, from the Swedish Intensive Care Register (SIR), where intensive care unit (ICU) admissions in 2009-2010 were matched with the corresponding hospital admissions in the Swedish Hospital Discharge Register. Recalibrated SAPS (Simplified Acute Physiology Score) 3 models were developed to predict and compare in-hospital and 30-day mortality. SMR based on in-hospital mortality and on 30-day mortality were compared between ICUs and between groups with different case-mixes, discharge destinations and length of hospital stays. RESULTS: Sixty-five ICUs with 48861 patients, of which 35610 were SAPS 3 scored, were included. Thirty-day mortality (17%) was higher than in-hospital mortality (14%). The SMR based on 30-day mortality and that based on in-hospital mortality differed significantly in 7/53 ICUs, for patients with sepsis, for elective surgery-admissions and in groups categorised according to discharge destination and hospital length of stay. CONCLUSION: Choice of mortality end-point influences SMR. The extent of the influence depends on hospital-, ICU- and patient cohort characteristics as well as inter-hospital transfer rates, as all these factors influence the difference between SMR based on 30-day mortality and SMR based on in-hospital mortality.
Authors: Anders Granholm; Anders Perner; Mette Krag; Peter Buhl Hjortrup; Nicolai Haase; Lars Broksø Holst; Søren Marker; Marie Oxenbøll Collet; Aksel Karl Georg Jensen; Morten Hylander Møller Journal: BMJ Open Date: 2017-03-09 Impact factor: 2.692
Authors: Leonie de Munter; Nancy C W Ter Bogt; Suzanne Polinder; Charlie A Sewalt; Ewout W Steyerberg; Mariska A C de Jongh Journal: PLoS One Date: 2018-12-18 Impact factor: 3.240
Authors: Nathan J Smischney; Andrew D Shaw; Wolf H Stapelfeldt; Isabel J Boero; Qinyu Chen; Mitali Stevens; Ashish K Khanna Journal: Crit Care Date: 2020-12-07 Impact factor: 9.097