Frailty and Long-Term Survival in Patients With Critical Illness After Nonhome Discharge: A Retrospective Cohort Study
Hardik Mehta, Ryan Ruiyang Ling, Mahesh Ramanan, Catherine Bartlett, Jatinder Grewal, Kshityj Gupta, James D. Reynolds, Aashish Kumar, Prashanti Marella, David Pilcher, Nilesh Shah, Kiran Shekar, Ashwin Subramaniam
Abstract
IMPORTANCE: Patients with frailty are more frequently discharged to rehabilitation or residential aged care facility (RACF), defined as nonhome discharge, than those without frailty. An increase in nonhome discharge is considered to be one of the collateral "costs" associated with declining hospital mortality. However, it is unclear whether this association applies to patients with frailty, particularly in the long term. OBJECTIVES: To determine the impact of frailty on long-term survival in patients who had a nonhome discharge following an ICU admission. DESIGN: A retrospective multicenter cohort study. SETTING AND PARTICIPANTS: All medical patients (≥ 16 yr old) admitted to Australian and Zealand ICUs, with a documented Clinical Frailty Scale (CFS) and a nonhome discharge from January 1, 2018, to March 31, 2022, were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary outcome was survival time up to 4 years. We used Cox proportional hazards regression models with robust sandwich variance estimators to assess the effect of frailty (defined as CFS = 5-8) on survival time after ICU admission between groups. We also analyzed the effect of frailty on long-term survival based on their age and nonhome discharge location. Of the 57,652 patients, 17,383 (30.2%) were frail. Overall 4-year survival was lower in patients with frailty than those without (32.5% vs. 64.3%; p < 0.001). Frailty was associated with shorter survival times (adjusted hazard ratio [aHR], 1.50; 95% CI, 1.43-1.57). Frailty was associated with a greater reduction in survival in patients younger than 65 years old (aHR, 1.73; 95% CI, 1.59-1.88), 65-80 years (aHR, 1.47; 95% CI, 1.38-1.57), or older than 80 years (aHR, 1.35; 95% CI, 1.26-1.45). Frailty was associated with greater reduction in survival in those discharged to rehabilitation (aHR, 1.52; 95% CI, 1.39-1.65) or acute hospitals (aHR, 1.56; 95% CI, 1.48-1.65) than those discharged to RACF (aHR, 0.94; 95% CI, 0.83-1.06). CONCLUSIONS: Frailty was independently associated with shorter time to death following a nonhome discharge after an ICU admission. RELEVANCE: There was an independent association between patients with frailty admitted to ICU and had a nonhome discharge with the shorter time to death than those without frailty.