Incidence, risk and impact of ICU readmission on patient outcomes and resource utilisation in tertiary level ICUs in Nepal: A cohort study
Issued Date
2025-01-01
Resource Type
eISSN
2398502X
Scopus ID
2-s2.0-105002988478
Journal Title
Wellcome Open Research
Volume
7
Rights Holder(s)
SCOPUS
Bibliographic Citation
Wellcome Open Research Vol.7 (2025)
Suggested Citation
Aryal D., Paneru H.R., Koirala S., Khanal S., Acharya S.P., Karki A., Dona D.G., Haniffa R., Beane A., Salluh J.I.F. Incidence, risk and impact of ICU readmission on patient outcomes and resource utilisation in tertiary level ICUs in Nepal: A cohort study. Wellcome Open Research Vol.7 (2025). doi:10.12688/wellcomeopenres.18381.3 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/109797
Title
Incidence, risk and impact of ICU readmission on patient outcomes and resource utilisation in tertiary level ICUs in Nepal: A cohort study
Author's Affiliation
Mahidol Oxford Tropical Medicine Research Unit
Instituto D'Or de Pesquisa e Ensino
Tribhuvan University Teaching Hospital
MRC Centre for Inflammation Research
Universidade Federal do Rio de Janeiro
Grande International Hospital
Nepal Intensive Care Research Foundation
Hospital for Advanced Medicine and Surgery
National Intensive Care Surveillance
Instituto D'Or de Pesquisa e Ensino
Tribhuvan University Teaching Hospital
MRC Centre for Inflammation Research
Universidade Federal do Rio de Janeiro
Grande International Hospital
Nepal Intensive Care Research Foundation
Hospital for Advanced Medicine and Surgery
National Intensive Care Surveillance
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Readmissions to Intensive Care Units (ICUs) result in increased morbidity, mortality, and ICU resource utilisation (e.g. prolonged mechanical ventilation), and as such, is a widely utilised metric of quality of critical care. Most of the evidence on incidence, characteristics, associated risk factors and attributable outcomes of readmission to ICU are from studies performed in high-income countries This study explores the determinants of risk attributable to ICU readmission in four ICUs in Kathmandu, Nepal. Methods: The registry reported data on case mix, severity of illness, in-ICU interventions (including organ support), ICU outcome, and readmission characteristics. Data were captured in all adult patients admitted between September 2019 and February 2021. Population and ICU encounter characteristics were compared between those with and without readmission. Independent risk factors for readmission were assessed using univariate analysis. Results: In total 2955 patients were included in the study. Absolute ICU readmission rate was 5.69 % (n=168) for all four ICUs. Median time from ICU discharge to readmission was 3 days (IQR=8,1). Of those readmitted, 29.17% (n=49) were discharged at night following their index admission. ICU mortality was higher following readmission to ICU(p=0.016) and mortality was increased further in patients whose primary index discharge was at night(p= 0.019). Primary diagnosis, age, and use of organ support in the first 24hrs of index admission were all independently attributable risk factors for readmission. Conclusions: ICU readmission rates were adversely associated with significantly poorer outcomes, increased ICU resource utilisation. Clinical and organisational characteristics influenced risk of readmission and outcome.