Survival of critically ill surgical patients discharged to extended care facilities

Background: Rates of discharge of surgical ICU (SICU) patients to extended care facilities (ECF) increase as SICU length of stay (LOS) increases. Incr eased SICU LOS and APACHE II scores have been related to increased hospital mortality This study evaluated factors influencing ECF survival after SICU patient discharge. Study Design: We did a longitudinal followup study of patients admitted to our tertiary care SICU during a 2-year period who were eventually discharge d to ECE Demographic data, SICU admission APACHE II score, and LOS data wer e obtained prospectively. Patient followup was obtained 2 years after disch arge by telephone interviews with patients themselves or next of kin to asc ertain current status or date of demise. Results: Of 1,799 SICU patients admitted during the study period, 160 patie nts (9%) were discharged to an ECE Telephone followup was obtained from 150 patients (94%). Mean length of followup was 21 months after hospital disch arge (range 7 to 34 months), mean patient age 64 years (range 16 to 96 year s), mean SICU admission APACHE II score 13 (range 2 to 29), and mean SICU L OS 11 days (range 1 to 146 days). At followup, 45% of patients had died, 37 % had been discharged home, and 18% still resided in an ECF or hospital. El derly patients (above age 65) had significantly worse 1-year (p < 0.001) an d 2-year (p < 0.001) ECF survival than nonelderly patients, Patients admitt ed to the SICU after otolaryngologic procedures also had significantly wors e 1- and 2-year ECF survival than all other patients. Severity of illness a s estimated by admission APACHE II scores or SICU LOS does not seem to infl uence survival. Conclusions: Outcomes of ECF discharge after SICU admission is poor, with n early 50% 2-year mortality. ECF mortality seems significantly higher for th e elderly, with patients undergoing otolaryngologic procedures being at hig hest risk. Severity of illness at the time of SICU admission and SICU LOS d oes not seem to influence ECF outcomes. (J Am Cell Surg 1999;189:437-441. ( C) 1999 by the American College of Surgeons).