Nighttime intensive care unit discharge and outcomes: A propensity matched retrospective cohort study

• Published in: PloS one Vol. 13; no. 12; p. e0207268
• Main Authors: Corrêa, Thiago Domingos, Ponzoni, Carolina Rodrigues, Filho, Roberto Rabello, Neto, Ary Serpa, Chaves, Renato Carneiro de Freitas, Pardini, Andreia, Assunção, Murillo Santucci Cesar, Schettino, Guilherme De Paula Pinto, Noritomi, Danilo Teixeira
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13-12-2018; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Biology and Life Sciences; Chi-square test; Cohort analysis; Cohort Studies; Critical care; Daytime; Economic aspects; Female; Health care costs; Hospital admission and discharge; Hospitals; Humans; Intensive care; Intensive care units; Intensive Care Units - statistics & numerical data; Male; Management; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Night; Nighttime; Patient Discharge - statistics & numerical data; Patients; People and Places; Physical Sciences; Propensity Score; Research and Analysis Methods; Retrospective Studies; Services; Studies; Surgery; Systematic review; Time Factors; Brazil; Australia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0207268

Nighttime ICU discharge, i.e., discharge from the ICU during the night hours, has been associated with increased readmission rates, hospital length of stay (LOS) and in-hospital mortality. We sought to determine the frequency of nighttime ICU discharge and identify whether nighttime ICU discharge is associated with worse outcomes in a private adult ICU located in Brazil.
Post hoc analysis of a cohort study addressing the effect of ICU readmissions on outcomes. This retrospective, single center, propensity matched cohort study was conducted in a medical-surgical ICU located in a private tertiary care hospital in São Paulo, Brazil. Based on time of transfer, patients were categorized into nighttime (7:00 pm to 6:59 am) and daytime (7:00 am to 6:59 pm) ICU discharge and were propensity-score matched at a 1:2 ratio. The primary outcome of interest was in-hospital mortality.
Among 4,313 eligible patients admitted to the ICU between June 2013 and May 2015, 1,934 patients were matched at 1:2 ratio [649 (33.6%) nighttime and 1,285 (66.4%) daytime discharged patients]. The median (IQR) cohort age was 66 (51-79) years and SAPS III score was 43 (33-55). In-hospital mortality was 6.5% (42/649) in nighttime compared to 5.6% (72/1,285) in daytime discharged patients (OR, 1.17; 95% CI, 0.79 to 1.73; p = 0.444). While frequency of ICU readmission (OR, 0.95; 95% CI, 0.78 to 1.29; p = 0.741) and length of hospital stay did not differ between the groups, length of ICU stay was lower in nighttime compared to daytime ICU discharged patients [1 (1-3) days vs. 2 (1-3) days, respectively, p = 0.047].
In this propensity-matched retrospective cohort study, time of ICU discharge did not affect in-hospital mortality.