Brendan J Clark1, Anna D Rubinsky2,3, P Michael Ho4,5, David H Au3, Laura J Chavez3, Marc Moss1, Katharine A Bradley2,3,6. 1. a Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado , Aurora , Colorado , USA. 2. b Center of Excellence for Substance Abuse Treatment and Education , Department of Veterans Affairs Puget Sound Health Care System , Seattle , Washington , USA. 3. c Health Services Research and Development , Department of Veterans Affairs Puget Sound Health Care System , Seattle , Washington , USA. 4. d Division of Cardiology, Department of Medicine, Denver VA Medical Center , Denver , Colorado , USA. 5. e Department of Medicine , Division of Cardiology, University of Colorado , Aurora , Colorado , USA. 6. f Group Health Research Institute , Seattle , Washington , USA.
Abstract
BACKGROUND: The association between alcohol misuse and the need for intensive care unit admission as well as hospital readmission among those discharged from the hospital following a critical illness is unclear. This study sought to determine whether alcohol misuse was associated with (1) admission to an intensive care unit (ICU) among a cohort of patients receiving outpatient care and (2) hospital readmission among those discharged from the hospital following critical illness. METHODS: This was a retrospective cohort study conducted with data from 24 Veterans Affairs (VA) health care facilities between 2004 and 2007. Scores on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire were used to identify patients with past-year abstinence, lower-risk alcohol use, moderate alcohol misuse, or severe alcohol misuse. The primary outcome was admission to a VA intensive care unit within the year following administration of the AUDIT-C. In an analysis focused on patients discharged from the ICU, the 2 main outcomes were hospital readmission within 1 year and within 30 days. RESULTS: Among 486,115 veterans receiving outpatient care, the adjusted probability of ICU admission within 1 year was 2.0% (95% confidence interval [CI]: 1.7%-2.3%) for abstinent patients, 1.6% (95% CI: 1.3%-1.8%) for patients with lower-risk alcohol use, 1.8% (1.4%-2.3%) for patients with moderate alcohol misuse, and 2.5% (2.0%-2.9%) for patients with severe alcohol misuse. Among the 9,030 patients discharged from an ICU, the adjusted probability of hospital readmission within 1 year was 48% (46%-49%) in abstinent patients, 44% (42%-45%) in patients with lower-risk alcohol use, 42% (39%-45%) in patients with moderate alcohol misuse, and 55% (49%-60%) in patients with severe alcohol misuse. CONCLUSIONS: Alcohol misuse may represent a modifiable risk factor for a cycle of ICU admission and subsequent hospital readmission.
BACKGROUND: The association between alcohol misuse and the need for intensive care unit admission as well as hospital readmission among those discharged from the hospital following a critical illness is unclear. This study sought to determine whether alcohol misuse was associated with (1) admission to an intensive care unit (ICU) among a cohort of patients receiving outpatient care and (2) hospital readmission among those discharged from the hospital following critical illness. METHODS: This was a retrospective cohort study conducted with data from 24 Veterans Affairs (VA) health care facilities between 2004 and 2007. Scores on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire were used to identify patients with past-year abstinence, lower-risk alcohol use, moderate alcohol misuse, or severe alcohol misuse. The primary outcome was admission to a VA intensive care unit within the year following administration of the AUDIT-C. In an analysis focused on patients discharged from the ICU, the 2 main outcomes were hospital readmission within 1 year and within 30 days. RESULTS: Among 486,115 veterans receiving outpatient care, the adjusted probability of ICU admission within 1 year was 2.0% (95% confidence interval [CI]: 1.7%-2.3%) for abstinent patients, 1.6% (95% CI: 1.3%-1.8%) for patients with lower-risk alcohol use, 1.8% (1.4%-2.3%) for patients with moderate alcohol misuse, and 2.5% (2.0%-2.9%) for patients with severe alcohol misuse. Among the 9,030 patients discharged from an ICU, the adjusted probability of hospital readmission within 1 year was 48% (46%-49%) in abstinent patients, 44% (42%-45%) in patients with lower-risk alcohol use, 42% (39%-45%) in patients with moderate alcohol misuse, and 55% (49%-60%) in patients with severe alcohol misuse. CONCLUSIONS:Alcohol misuse may represent a modifiable risk factor for a cycle of ICU admission and subsequent hospital readmission.
Entities:
Keywords:
Alcohol abuse; alcohol consumption; alcohol-related disorders; health care utilization; intensive care units; patient readmission
Authors: Brendan J Clark; Alexandra Smart; Robert House; Ivor Douglas; Ellen L Burnham; Marc Moss Journal: Alcohol Clin Exp Res Date: 2011-09-26 Impact factor: 3.455
Authors: Anna D Rubinsky; Michael J Bishop; Charles Maynard; William G Henderson; Mary T Hawn; Alex H S Harris; Lauren A Beste; Hanne Tønnesen; Katharine A Bradley Journal: Drug Alcohol Depend Date: 2013-05-16 Impact factor: 4.492
Authors: Marc Moss; Polly E Parsons; Kenneth P Steinberg; Leonard D Hudson; David M Guidot; Ellen L Burnham; Stephanie Eaton; George A Cotsonis Journal: Crit Care Med Date: 2003-03 Impact factor: 7.598
Authors: Emily C Williams; Chris L Bryson; Haili Sun; Ryan B Chew; Lisa D Chew; David K Blough; David H Au; Katharine A Bradley Journal: Am J Drug Alcohol Abuse Date: 2011-07-29 Impact factor: 3.829
Authors: Gwen T Lapham; Carol E Achtmeyer; Emily C Williams; Eric J Hawkins; Daniel R Kivlahan; Katharine A Bradley Journal: Med Care Date: 2012-02 Impact factor: 2.983
Authors: David H Au; Daniel R Kivlahan; Chris L Bryson; David Blough; Katharine A Bradley Journal: Alcohol Clin Exp Res Date: 2007-03 Impact factor: 3.455
Authors: Eric J Hawkins; Daniel R Kivlahan; Emily C Williams; Steven M Wright; Thomas Craig; Katharine A Bradley Journal: Subst Abus Date: 2007 Impact factor: 3.716
Authors: Brendan J Clark; Jacqueline Jones; K Diandra Reed; Rachel Hodapp; Ivor S Douglas; David Van Pelt; Ellen L Burnham; Marc Moss Journal: Ann Am Thorac Soc Date: 2017-07
Authors: Dan V Blalock; Janet Grubber; Valerie A Smith; Donna M Zulman; Hollis J Weidenbacher; Liberty Greene; Eric A Dedert; Matthew L Maciejewski Journal: Alcohol Clin Exp Res Date: 2021-05-04 Impact factor: 3.928
Authors: Brendan J Clark; Tanya Sorrell; Rachel M Hodapp; Kathryne Reed; Marc Moss; Laurra Aagaard; Paul F Cook Journal: Crit Care Explor Date: 2019-10-14
Authors: Joseph C Osborne; Susan E Horsman; Kristin C Mara; Thomas C Kingsley; Robert W Kirchoff; Jonathan G Leung Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2021-12-20