Background
Methods
Patients and setting
Context of the study in Belgium
Data collection
Statistical analysis
Results
Characteristics | Total (n = 18 235) |
---|---|
Age, years, mean ± SD | 63.1 ± 16.8 |
Geriatric cases (> 75 years), n (%) | 4,386 (24.8) |
Men, n (%) | 10,663 (58.5) |
Charlson score, median [IQR] | 4.4 [2.3–7.4] |
Ventilated patients, n (%) | 5,552 (30.4) |
Mechanical ventilation time in days, median [IQR] | 4 [2–8] |
Measurement of intracranial pressure, n (%) | 197 (1.0) |
ECMO, n (%) | 93 (0.5) |
Continuous hemofiltration, n (%) | 753 (4.1) |
ICU LOS in days, median [IQR] | 1.8 [0.8–3.7] |
Hospital LOS in days, median [IQR] | 9.3 [4.8–17.6] |
ICU Readmission, n (%) | 1,136 (6.2) |
ICU mortality, n (%) | 1,882 (10.3) |
Hospital mortality, n (%) | 2,432 (13.3) |
Main diagnosis, n (%) | |
Sepsis/septic shock | 1,323 (7.3) |
Cardiogenic shock/cardiac decompensation | 3,038 (16.7) |
Decompensation of chronic respiratory failure | 991 (5.4) |
Coma/convulsion | 3,088 (16.9) |
Intoxication | 474 (2.6) |
Heart surgery | 2,651 (14.6) |
Digestive surgery | 2,916 (16.0) |
Post-operative monitoring for minor surgical procedures | 3,110 (17.0) |
Other | 644 (3.5) |
Hospitals (n = 17) | University hospital | Occupancy rate ICU (%) | Proportion of ICU beds to ward beds (%) | Proportion of indirect costs ICU on the total cost (%) | Proportion of nursing costs to direct costs ICU (%) | Nurse cost ICU/ward nurse cost (%) | FTE nurse per ICU bed | Cost of one FTE nurse (€) | Median cost per stay per hospital (€) |
---|---|---|---|---|---|---|---|---|---|
1 | No | 74.0 | 3.0 | 13.0 | 55.0 | 12.0 | 2.07 | 75,968 | 3,003 |
2 | No | 76.8 | 6.0 | 12.6 | 56.7 | 18.4 | 2.17 | 74,630 | 6,112 |
3 | No | 62.3 | 5.7 | 11.4 | 59.5 | 18.2 | 1.71 | 74,373 | 4,595 |
4 | No | 82.6 | 4.7 | 13.4 | 47.2 | 17.8 | 2.81 | 72,983 | 8,641 |
5 | No | 68.7 | 3.4 | 13.3 | 57.2 | 13.6 | 2.48 | 67,932 | 4,903 |
6 | Yes | 76.1 | 4.4 | 8.2 | 57.9 | 12.7 | 2.69 | 79,429 | 3,429 |
7 | Yes | 85.8 | 7.3 | 11.4 | 65.3 | 28.8 | 2.92 | 82,251 | 3,996 |
8 | No | 87.0 | 5.0 | 15.5 | 56.3 | 23.2 | 2.97 | 77,352 | 5,793 |
9 | No | 71.7 | 4.9 | 15.7 | 59.9 | 17.5 | 2.19 | 75,593 | 5,884 |
10 | No | 78.0 | 6.5 | 9.0 | 62.2 | 23.1 | 2.89 | 76,113 | 5,251 |
11 | No | 89.9 | 2.7 | 17.8 | 65.4 | 11.8 | 2.38 | 82,101 | 4,454 |
12 | No | 98.1 | 3.7 | 11.9 | 35.4 | 15.9 | 2.48 | 70,641 | 7,376 |
13 | No | 66.8 | 5.9 | 12.1 | 51.2 | 16.8 | 2.56 | 70,326 | 3,217 |
14 | No | 69.0 | 4.5 | 13.1 | 71.4 | 11.4 | 2.60 | 76,234 | 3,216 |
15 | Yes | 82.0 | 4.5 | 10.8 | 68.4 | 12.1 | 3.21 | 81,273 | 3,077 |
16 | No | 82.1 | 4.5 | 10.6 | 55.4 | 14.1 | 1.90 | 70,054 | 3,490 |
17 | No | 69.5 | 3.4 | 11.9 | 56.4 | 8.2 | 2.19 | 67,555 | 2,466 |
Median [IQR] or n (%) | 3 (18) | 76.8 [69.5–83.3] | 4.6 [3.7–5.7] | 12.1 [11.4–13.3] | 57.2 [55.4–62.2] | 15.9 [12.0-18.2] | 2.50 [2.10–2.80] | 75,593 [70,641 − 77,353] | 4,454 [3,217 -5,815] |
Univariate linear regression* | Multivariate linear regression ** | ||||
---|---|---|---|---|---|
Factors | Total cost (€) | Not Adjusted | Adjusted | Adjusted | p value |
Geometric Mean (95%CI) | coefficient (95%IC) | coefficient (95%IC) | GMR** (95%CI) | ||
Geriatric cases | |||||
Not geriatrics case | 4,453 (4,365 to 4,543) | Ref | Ref | Ref | |
Geriatrics case (> 75 years) | 4,798 (4,639 to 4,963) | 0.07 (0.03 to 0.11) | -0.05 (-0.07 to -0.02) | 0.95 (0.93 to 0.97) | < 0.0001 |
Gender | |||||
Men | 4,767 (4,661 to 4,875) | Ref | Ref | Ref | |
Women | 4,225 (4,114 to 4,340) | -0.12 (-0.15 to -0.09) | -0.02 (-0.04 to 0.00) | 0.99 (0.96 to 1.00) | 0.068 |
Charlson score | |||||
0 (n = 2 741) | 2,938 (2,807 to 3,077) | Ref | Ref | Ref | |
1–3 (n = 3 367) | 4,061 (3,907 to 4,221) | 0.32 (0.26 to 0.38) | 0.12 (0.08 to 0.15) | 1.13 (1.09 to 1.17) | < 0.0001 |
4–5 (n = 4 319) | 4,560 (4,404 to 4,720) | 0.44 (0.38 to 0.45) | 0.12 (0.09 to 0.16) | 1.13 (1.09 to 1.17) | |
6+ (n = 7 806) | 5,519 (5,379 to 5,662) | 0.63 (0.58 to 0.68) | 0.17 (0.14 to 0.20) | 1.19 (1.15 to 1.23) | |
Mechanical ventilation | |||||
Not ventilated patients | 2,972 (2,920 to 3,024) | Ref | Ref | Ref | |
Ventilated patients | 11,899 (11,598 to 12,209) | 1.39 (1.36 to 1.43) | 0.55 (0.53 to 0.58) | 1.74 (1.63 to 1.86) | < 0.0001 |
ECMO | |||||
Patients without ECMO | 4,485 (4,409 to 4,562) | Ref | Ref | Ref | |
Patients with ECMO | 37,859 (31,946 to 44,865) | 2.13 (1.95 to 2.30) | 0.63 (0.45 to 0.77) | 1.88 (1.63 to 2.17) | < 0.0001 |
Continuous hemofiltration | |||||
Patients without continuous hemofiltration | 4,223 (4,152 to 4,295) | Ref | Ref | Ref | |
Patient with continuous hemofiltration | 23,624 (22,064 to 25,294) | 1.72 (1.64 to 1.79) | 0.40 (0.43 to 0.53) | 1.62 (1.54 to 1.70) | < 0.0001 |
ICU LOS in quartiles | < 0.0001 | ||||
Quartile 1 [0–1] (n = 4,562) | 1,454 (1,416 to 1,494) | Ref | Ref | Ref | |
Quartile 2 [1-2] (n = 4,551) | 2,930 (2,875 to 2,987) | 0.70 (0.67 to 0.73) | 0.67 (0.64 to 0.70) | 1.96 (1.91 to 2.02) | |
Quartile 3 [2-4] (n = 4,562) | 5,593 (5,499 to 5,688) | 1.35 (1.32 to 1.37) | 1.24 (1.21 to 1.27) | 3.47 (3.36 to 3.57) | |
Quartile 4 [4-max] (n = 4,558) | 17,726 (17,331 to 18,131) | 2.500 (2.47 to 2.53) | 2.12 (2.09 to 2.15) | 8.33 (8.06 to 8.61) | |
Readmission ICU | |||||
Patients not readmitted | 4,218 (4,145 to 4,269) | Ref | Ref | Ref | |
Patients readmitted | 13,448 (12,612 to 14,340) | 1.16 (1.09 to 1.23) | 0.15 (0.115 to 0.19) | 1.17 (1.12 to 1.21) | < 0.0001 |
ICU mortality | |||||
Surviving patients | 3,954 (3,885 to 4,024) | Ref | Ref | Ref | |
Deceased patients | 10,795 (10,316 to 11,295) | 1.00 (0.96 to 1.05) | 0.33 (0.30 to 0.36) | 1.39 (1.34 to 1.43) | < 0.0001 |
Hospital academic | |||||
Inpatients non-academic hospital | 4,659 (4,563 to 4,758) | Ref | Ref | Ref | |
Inpatients academic hospital | 4,274 (4,147 to 4,405) | − 0.09 (-0.13 to -0.50) | 0.14 (0.12 to 0.16) | 1.15 (1.13 to 1.18) | < 0.0001 |
Main diagnosis | |||||
Cardiogenic shock/ cardiac decompensation | 3,254 (3,124 to 3,390) | Ref | Ref | Ref | < 0.0001 |
Coma/convulsion | 4,218 (4,062 to 4,380) | 0.26 (0.20 to 0.32) | 0.13 (0.09 to 0.16) | 1.14 (1.10 to 1.18) | |
Decompensation of chronic respiratory failure | 6,821 (6,385 to 7,287) | 0.74 (0.67 to 0.82) | -0.039 (-0.09 to 0.01) | 0.96 (0.92 to 1.00) | |
Sepsis/sepsis shock | 6,514 (6,122 to 6,932) | 0.20 (0.14 to 0.26) | -0.01 (-0.04 to 0.03) | 0.99 (0.96 to 1.03) | |
Intoxication | 3,701 (3,399 to 4,030) | 0.76 (0.70 to 0.82) | 0.06 (0.02 to 0.09) | 1.06 (1.02 to 1.10) | |
Heart surgery | 6,978 (6,687 to 7,281) | 0.13 (0.02 to 0.24) | -0.07 (-0.13 to -0.00) | 0.93 (0.89 to 0.98) | |
Digestive surgery | 3,978 (3,803 to 4,161) | 0.03 (-0.07 to 0.13) | -0.01 (-0.15 to -0.04) | 0.91 (0.86 to 0.96) | |
Post-operative monitoring | 4,355 (4,167 to 4,552) | 0.29 (0.23 to 0.35) | 0.00 (-0.03 to 0.03) | 1.00 (0.97 to 1.04) | |
Other | 3,351 (3,077 to 3,650) | 0.69 (0.62 to 0.77) | 0.05 (0.01 to 0.09) | 1.05 (0.976 to 1.10) |