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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

Outcomes of prolonged mechanic ventilation: a discrimination model based on longitudinal health insurance and death certificate data

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2012
Autoren:
Hsin-Ming Lu, Likwang Chen, Jung-Der Wang, Mei-Chuan Hung, Ming-Shian Lin, Yuan-Horng Yan, Cheng-Ren Chen, Po-Sheng Fan, Lynn Chu Huang, Ken N Kuo
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-100) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

All the authors helped in obtaining research data and funding, and participated in study design and preparation of the draft. HL took major responsibility for data analysis and interpretation. LC oversaw the study and took major responsibility for writing the draft. All authors read and approved the final manuscript.

Abstract

Background

This study investigated prognosis among patients under prolonged mechanical ventilation (PMV) through exploring the following issues: (1) post-PMV survival rates, (2) factors associated with survival after PMV, and (3) the number of days alive free of hospital stays requiring mechanical ventilation (MV) care after PMV.

Methods

This is a retrospective cohort study based on secondary analysis of prospectively collected data in the national health insurance system and governmental data on death registry in Taiwan. It used data for a nationally representative sample of 25,482 patients becoming under PMV (> = 21 days) during 1998-2003. We calculated survival rates for the 4 years after PMV, and adopted logistic regression to construct prediction models for 3-month, 6-month, 1-year, and 2-year survival, with data of 1998-2002 for model estimation and the 2003 data for examination of model performance. We estimated the number of days alive free of hospital stays requiring MV care in the immediate 4-year period after PMV, and contrasted patients who had low survival probability with all PMV patients.

Results

Among these patients, the 3-month survival rate was 51.4%, and the 1-year survival rate was 31.9%. Common health conditions with significant associations with poor survival included neoplasm, acute and unspecific renal failure, chronic renal failure, non-alcoholic liver disease, shock and septicaemia (odd ratio < 0.7, p < 0.05). During a 4-year follow-up period for patients of year 2003, the mean number of days free of hospital stays requiring MV was 66.0 in those with a predicted 6-month survival rate < 10%, and 111.3 in those with a predicted 2-year survival rate < 10%. In contrast, the mean number of days was 256.9 in the whole sample of patients in 2003.

Conclusions

Neoplasm, acute and unspecific renal failure, shock, chronic renal failure, septicemia, and non-alcoholic liver disease are significantly associated with lower survival among PMV patients. Patients with anticipated death in a near future tend to spend most of the rest of their life staying in hospital using MV services. This calls for further research into assessing PMV care need among patients at different prognosis stages of diseases listed above.
Zusatzmaterial
Additional file 1: Disease categorization. (XLS 45 KB)
12913_2011_2011_MOESM1_ESM.XLS
Additional file 2: Odds ratios for all explanatory variables. (DOC 383 KB)
12913_2011_2011_MOESM2_ESM.DOC
Additional file 3: Receiver operating characteristic curves. (DOC 175 KB)
12913_2011_2011_MOESM3_ESM.DOC
Additional file 4: Classification tables for comparing predicted outcomes with actual outcomes. (DOC 74 KB)
12913_2011_2011_MOESM4_ESM.DOC
Authors’ original file for figure 1
12913_2011_2011_MOESM5_ESM.pdf
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