Long-term outcomes and healthcare utilization following prolonged mechanical ventilation

Rationale — Limited data are available to characterize the long-term outcomes and associated costs for patients who require prolonged mechanical ventilation (PMV) (defined here as mechanical ventilation for longer than 21 days).

Objectives — To examine the association between prolonged mechanical ventilation and mortality, healthcare utilization, and costs after critical illness.

Methods — Population-based cohort study of adults who received mechanical ventilation in an intensive care unit (ICU) in Ontario, Canada between 2002 and 2013.

Measurement and Main Results — We used linked administrative databases to determine discharge disposition, and ascertain one-year mortality (primary outcome), readmissions to hospital and ICU, and healthcare costs for hospital survivors. Overall, 11,594 (5.4%) patients underwent prolonged mechanical ventilation, with 42.4% of patients dying in the hospital (vs. 27.6% of patients who did not undergo prolonged ventilation, p<0.0001). Prolonged ventilation patients were more frequently discharged to other facilities or home with healthcare support (84.8% versus 43.5%, p < 0.0001). Among hospital survivors, estimated mortality was higher for patients who underwent prolonged mechanical ventilation: 16.6% vs. 11% at 1 year and 42.0% vs. 30.4% at 5 years. One year following hospital discharge, prolonged ventilation patients had higher rates of hospital readmission (47.2% vs. 37.7%; adjusted odds ratio (aOR) 1.20, 95% confidence interval (CI): 1.14, 1.26), ICU readmission (19.0% vs. 11.6%; aOR: 1.49, 95%CI: 1.39, 1.60), and total healthcare costs: median (IQR) CAN$32,526 ($20,821, $56,102) vs. CAN$13,657 ($5,946, $38,022). Increasing duration of mechanical ventilation was associated with higher mortality and healthcare utilization.

Conclusions — Critically ill patients who undergo mechanical ventilation in an ICU for for longer than 21 days have high in-hospital mortality and greater post-discharge mortality, healthcare utilization, and healthcare costs compared to patients undergo mechanical ventilation for a shorter period of time.