Original Research Article
Year: 2017 | Month: June | Volume: 7 | Issue: 6 | Pages: 65-71
Tracheostomy as an Independent Risk Factor of ICU Readmission
Waleed Th. Aletreby1, Basim M. Huwait1, Abdulrahman M. Al-Harthy1, Ahmed F. Madi1,2, Omar E. Ramadan1,3, Mohammed A. Al-Odat1, Shahzad A. Mumtaz1
1Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
2Anesthesia Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
3Anesthesia Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Corresponding Author: Waleed Th. Aletreby
Readmission to Intensive Care Unit (ICU) is associated with poor patients’ outcomes. Prediction of risk of ICU readmission may help improve discharge decision making. Tracheostomies are increasing in ICU because of the safety of the procedure, and its benefits in patients’ management. However, studies are scarce on the evaluation of tracheostomy as an independent risk factor of ICU readmission.
Objective: To investigate whether discharge from ICU with tracheostomy is an independent risk factor of ICU readmission.
Design: Retrospective single-center observational study, on patients discharged from ICU of King Saud Medical City (KSA – Riyadh) to identify differences between readmitted and non-readmitted patients, and recognize independent risks of readmission through logistic regression.
Results: Readmitted patients had higher average age and average APACHE 4 score, longer average length of stay, lower GCS on discharge, more tracheostomized patients, and were more frequently medical cases. A well fitted multivariate logistic regression model identified Age (OR 1.011, 95% CI: 1.001 – 1.021), LOS (OR 1.013, 95% CI: 1.004 – 1.021), APACHE 4 score (OR 1.01, 95% CI: 1.003 – 1.017), GCS (OR 0.86, 95% CI: 0.78 – 0.95), and tracheostomy (OR 2.7, 95% CI: 1.4 - 5) as risk factors of ICU readmission. The predictive model of readmission had AUC of 0.82(95% CI: 0.78 – 0.86). A predictive nomogram of the probability of readmission was constructed to be used for individual patients using these five factors.
Conclusion: There is evidence that discharge from the ICU with tracheostomy is an independent risk of ICU readmission.
Key words: critical care, intensive care, risk factor, readmission, tracheostomy