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Adverse In-Hospital Events Are Associated With Increased In-Hospital Mortality and Length of Stay in Patients With or at Risk of Acute Respiratory Distress Syndrome

Published:January 28, 2015DOI:https://doi.org/10.1016/j.mayocp.2014.12.015

      Abstract

      Objective

      To explore the effect of various adverse hospital events on short- and long-term outcomes in a cohort of acutely ill hospitalized patients.

      Patients and Methods

      In a secondary analysis of a retrospective cohort of acutely ill hospitalized patients with sepsis, shock, or pneumonia or undergoing high-risk surgery who were at risk for or had developed acute respiratory distress syndrome between 2001 and 2010, the effects of potentially preventable hospital exposures and adverse events (AEs) on in-hospital and intensive care unit (ICU) mortality, length of stay, and long-term survival were analyzed. Adverse effects chosen for inclusion were inadequate empiric antimicrobial coverage, hospital-acquired aspiration, medical or surgical misadventure, inappropriate blood product transfusion, and injurious tidal volume while on mechanical ventilation.

      Results

      In 828 patients analyzed, the distribution of 0, 1, 2, and 3 or more cumulative AEs was 521 (63%), 126 (15%), 135 (16%), and 46 (6%) patients, respectively. The adjusted odds ratios (95% CI) for in-hospital mortality in patients who had 1, 2, and 3 or more AEs were 0.9 (0.5-1.7), 0.9 (0.5-1.6), and 1.4 (0.6-3.3), respectively. One AE increased the length of stay, difference between means (95% CI), in the hospital by 8.7 (3.8-13.7) days and in the ICU by 2.4 (0.6-4.2) days.

      Conclusion

      Potentially preventable hospital exposure to AEs is associated with prolonged ICU and hospital lengths of stay. Implementation of effective patient safety interventions is of utmost priority in acute care hospitals.

      Abbreviations and Acronyms:

      AE (adverse event), APACHE (Acute Physiology and Chronic Health Evaluation), ARDS (acute respiratory distress syndrome), ICU (intensive care unit), OR (odds ratio), RBC (red blood cell), TV (tidal volume)
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