Jb. Dimick et al., Intensive cave unit physician staffing is associated with decreased lengthof stay, hospital cost, and complications after esophageal resection, CRIT CARE M, 29(4), 2001, pp. 753-758
Objective: To determine whether having daily rounds by an intensive care un
it (ICU) physician is associated with clinical and economic outcomes after
esophageal resection.
Design:ICU information was obtained from a prospective survey and linked to
retrospective patient data from the Maryland Health Cervices Cost Review C
ommission. The main outcome variables were in-hospital mortality rate, leng
th of stay, hospital cost, and complications after esophageal resection.
Setting: Nonfederal acute care hospitals in Maryland that performed esophag
eal resection (n = 35 hospitals) during the study period, 1994-1998.
Patients: Adult patients who underwent esophageal resection in Maryland (n
= 366 patients) from 1994 to 1998, Interventions: Presence vs. absence of d
aily rounds by an ICU physician.
Measurements and Main Results:After adjusting for patient case-mix and othe
r hospital characteristics, lack of daily rounds by an ICU physician was in
dependently associated with a 73% increase in hospital length Of stay (7 da
ys; 95% confidence interval [CI], 1-15; p = .012) and a 61% increase in tot
al hospital cost ($8,839; 95% CI, $ 1,674-$19,192; p = .013), but there was
no association with in-hospital mortality rate. In addition, the following
postoperative complications were independently associated with lack of dai
ly rounds by an ICU physician: pulmonary insufficiency (odds ratio [OR], 4.
0; CI, 1.4-11.0), renal failure (OR, 6.3; CI, 1.4-28.7), aspiration (OR, 1.
7; CI, 1.0-2.8), and reintubation (OR, 2.8; CI, 1.5-5.2).
Conclusions: Having daily rounds by an ICU physician is associated with sho
rter lengths of stay, lower hospital cost, and decreased frequency of posto
perative complications after esophageal resection, Healthcare providers and
policymakers should use this information to help improve quality of care a
nd reduce costs for patients undergoing high-risk surgical procedures.