Prolonged hospitalization in intensive care unit; contributing factors and impact on mortality

Original Article = ANATOLIAN CURRENT MEDICAL DOT: 10.38053/acmj.1416658 Anatolian Curr Med J. 2024;6(2):185-190 Prolonged hospitalization in intensive care unit; contributing factors and impact on mortality @Elvan Tekir Yilmaz!, ©Yigit Sahin”, ©Bilge Olgun Keles', ®Ali Altinbas? 1Department of Anesthesiology and Reanimation, Faculty of Medicine, Giresun University, Giresun, Turkiye Department of Anesthesiology and Reanimation, Giresun Training and Resarch Hospital, Giresun, Turkiye Cite this article as: Tekir Yilmaz E, Sahin Y, Olgun Keles B, Altinbas A. Prolonged hospitalization in intensive care unit; contributing factors and impact on mortality. Anatolian Curr Med J. 2024;6(2):185-190. Received: 08.01.2024 + Accepted: 01.03.2024 ° Published: 08.03.2024 ABSTRACT Aims: Prolonged stay in the intensive care unit (ICU) is a significant problem. It contributes to increased costs, scarcity of resources, morbidity, and mortality. This study aims to investigate the factors contributing to prolonged ICU stay and its association with mortality. Methods: We retrospectively analysed 312 patients who stayed in the ICU between January 2020 and September 2023. Patients were divided into 2 groups according to the days of ICU stay: 14 days or more (Group 1) and 30 days or more (Group 2). The effects of APACHE II, SOFA, GCS, age, gender, duration and reason for hospitalization, mechanical ventilation type and duration, renal replacement therapy, tracheotomy, blood transfusion, procalcitonin and acute phase reactants on the length of stay in the ICU were analyzed. Results: A total of 299 patients were enrolled in the study. There were 112 patients who stayed in ICU for longer than 14 days (Group 1) and 187 patients who stayed for longer than 30 days (Group 2). The mean age of Group 1 was 68.6 years and the mean age of Group 2 was 70.9 years. In Group 1, male gender predominated with 62.5%, and in Group 2, it was 56.7%. Among the patients, 29.4% were hospitalized in the ICU for surgical reasons and 70.6% for non-surgical reasons. There were statistically significant differences between the groups regarding GCS, SOFA scores and PaO2, duration of mechanical ventilation, mechanical ventilation method, ICU mortality, renal-replacement therapy, tracheostomy status, and transfusion status (p<0.05). APACHE, expected mortality, lactate, procalcitonin, albumin, pH, PaCO2, HCOs’, and GFR, the reasons for ICU admission, comorbidities, and the existence of any infection were not significantly different between the groups. Conclusion: Age, MV duration, and SOFA score were found to be associated with both prolonged ICU stay and mortality. Regardless of mortality, there was a significant difference between the two groups in terms of GCS, tracheostomy, and the need for RRT. Keywords: Intensive care unit, length of stay, mortality INTRODUCTION Intensive care units (ICU) are specialized and advanced medical care units for critically ill patients. Providing that patients receive care in these units as indicated and as long as necessary plays an essential role in the efficient utilization of the available inpatient bed potential. The length of hospitalization in the ICU has been extending in recent years with the increase in the elderly population and the use of advanced treatment modalities. Length of stay (LOS) in intensive care unit is used as a measurement benchmark to ensure efficient use of health resources and to reduce costs." The type of intensive care unit and the patient profile results in different definitions of prolonged stays. Therefore, there is no complete consensus on the LOS. Corresponding Author: Elvan TEKIR YILMAZ, elvanty28@hotmail.com Despite the differences in definitions, an intensive care stay longer than 14 days has been associated with an increased risk of infection and costs, the duration of hospitalization before intensive care, age, and severity of the disease in different studies.”*® Various studies have indicated that as little as 4-11% of patients in the ICU are hospitalized for prolonged periods. Yet, this constitutes the majority of intensive care unit bed occupancy.”* Several studies have investigated the relationship between various factors and LOS in the ICU, most of which focused on specific populations or uniform ICUs.*"® In our study, 3"¢ level 4 ICU hospitalizations were analyzed. €<) OOO This work is licensed under a Creative Commons Attribution 4.0 International License. BY NC NO Yilmaz et al. Long stay in the ICU These were the Internal Medicine ICU, Neurology ICU, and General ICU where postoperative patients are followed up. Identifying the associated factors of prolonged ICU stays has become a priority for clinicians, hospital administrations, and healthcare policy, as it allows early identification of these patients. We believe that defining common criteria for different patient populations is important for standardisation. We hypothesised that ICU scoring systems, patients’ comorbidities, renal