| Resource-rich ICUs |
Standard ICUs |
||
|---|---|---|---|
| Characteristics | (n = 111) | (n = 347) | P-value |
| Annual ICU admissions, median (IQR) | 641 (461-947) | 499 (341-711) | <0.001 |
| Number of hospital beds, median (IQR) | 596 (490-798) | 448 (340-594) | <0.001 |
| Number of ICU beds, median (IQR) | 10 (8-13) | 8 (6-10) | <0.001 |
| Teaching hospital, n (%) | 97 (87) | 307 (88) | 0.76 |
| Academic hospital, n (%) | 46 (41) | 37 (11) | <0.001 |
| Number of dedicated nurses per ICU bed, median (IQR) | 3.4 (2.9-4.0) | 3.4 (2.9-4.0) | 0.94 |
| Dedicated pharmacist staffing, n (%) | 39 (35) | 64 (18) | <0.001 |
| Dedicated physical therapist staffing, n (%) | 9 (8) | 15 (4) | 0.12 |
| Resource-rich ICUs |
Standard ICUs |
||
|---|---|---|---|
| Characteristic | (n = 237,138) | (n = 552,492) | SMD |
| Age, years, median (IQR) | 70 (60-78) | 72 (62-79) | −13 |
| Male, n (%) | 143,493 (61) | 337,273 (61) | −1.1 |
| Body mass index at admission, kg/m2, n (%) | |||
| <18.5 | 29,465 (12) | 69,152 (13) | −0.3 |
| 18.5-24.9 | 139,097 (59) | 322,494 (58) | 0.6 |
| 25.0-29.9 | 47,120 (20) | 110,158 (20) | −0.2 |
| ≥30.0 | 11,405 (5) | 26,204 (5) | 0.3 |
| Missing data | 10,051 (4) | 24,484 (4) | −0.9 |
| Japan Coma Scale at admission, n (%) | |||
| Alert | 201,020 (85) | 448,656 (81) | 9.5 |
| Dizzy | 19,007 (8) | 53,680 (10) | −6 |
| Somnolent | 6,305 (3) | 19,846 (4) | −5.4 |
| Coma | 10,806 (5) | 30,310 (5) | −4.3 |
| Charlson Comorbidity Index, median (IQR) | 1.0 (0.0-2.0) | 1.0 (0.0-2.0) | 0.6 |
| Cognitive function before admission, n (%) | |||
| No dementia | 216,457 (91) | 486,852 (88) | 4.7 |
| Mild dementia | 13,889 (6) | 42,547 (8) | −7.3 |
| Moderate/severe dementia | 6,792 (3) | 23,093 (4) | −7.1 |
| Location before hospitalization, n (%) | |||
| Home | 217,750 (92) | 506,331 (92) | 0.7 |
| Other hospital | 16,058 (7) | 32,298 (6) | 3.8 |
| Nursing home | 3,330 (1) | 13,863 (3) | −8 |
| Time from admission to ICU entry, n (%) | |||
| On the day of admission | 61,896 (26) | 200,962 (36) | −22.3 |
| After 1 day | 37,225 (16) | 92,542 (17) | −2.9 |
| After 2-4 days | 73,191 (31) | 141,226 (26) | 11.8 |
| After >4 days | 64,826 (27) | 117,762 (21) | 14.1 |
| Fiscal year of admission, n (%) | |||
| 2016 | 80,997 (34) | 193,446 (35) | −1.8 |
| 2017 | 79,826 (34) | 187,672 (34) | −0.6 |
| 2018 | 76,315 (32) | 171,374 (31) | 2.5 |
| Type of ICU admission, n (%) | |||
| Elective surgery | 131,450 (55) | 245,299 (44) | 22.2 |
| Emergency surgery | 32,059 (14) | 83,522 (15) | −4.6 |
| Non-operative | 73,629 (31) | 223,671 (40) | −19.8 |
| Primary diagnosis, n (%) | |||
| Malignant neoplasms of digestive organs | 28,925 (12) | 74,423 (13) | −3.8 |
| Other neoplasm | 52,419 (22) | 88,479 (16) | 15.6 |
| Congestive heart failure | 29,284 (12) | 63,949 (12) | 2.4 |
| Ischemic heart diseases | 22,765 (10) | 68,181 (12) | −8.8 |
| Cerebrovascular diseases | 15,161 (6) | 51,601 (9) | −11 |
| Aortic aneurysm and dissection | 22,222 (9) | 41,940 (8) | 6.4 |
| Other diseases of the circulatory system | 10,651 (4) | 29,671 (5) | −4.1 |
| Diseases of the respiratory system | 7,312 (3) | 19,639 (4) | −2.6 |
| Diseases of the digestive system | 10,661 (4) | 32,641 (6) | −6.4 |
| Diseases of the connective tissue | 9,218 (4) | 17,016 (3) | 4.4 |
| Injury, poisoning, or external causes | 8,290 (3) | 23,084 (4) | −3.6 |
| Miscellaneous | 20,230 (9) | 41,868 (8) | 3.5 |
| Procedures on the day of ICU admission, n (%) | |||
| Invasive mechanical ventilation | 35,398 (15) | 76,229 (14) | 3.2 |
| Dopamine | 39,755 (17) | 86,631 (16) | 2.9 |
| Dobutamine | 32,756 (14) | 47,670 (9) | 16.5 |
| Noradrenaline | 68,044 (29) | 121,150 (22) | 15.6 |
| Adrenaline | 21,900 (9) | 37,180 (7) | 9.3 |
| Vasopressin | 3,976 (2) | 5,911 (1) | 5.2 |
| Red blood cell transfusion | 55,254 (23) | 98,382 (18) | 13.6 |
| Fresh frozen plasma transfusion | 39,278 (17) | 64,069 (12) | 14.3 |
| Platelet transfusion | 21,719 (9) | 33,424 (6) | 11.7 |
| Renal replacement therapy | 8,694 (4) | 16,284 (3) | 4 |
| Extracorporeal membrane oxygenation | 2,008 (1) | 3,615 (1) | 2.2 |
| ICU mortality | Generalized estimating equation | Instrumental variable | ||||
|---|---|---|---|---|---|---|
| Cohort | Resource-rich ICUs |
Standard ICUs |
Difference (95 % CI) |
P-value | Difference (95 % CI) |
P-value |
| Overall analysis | 8443/237,138 (3.6) | 23,490/552,492 (4.3) | −0.4 (−0.8 to 0.0) | 0.047 | −1.1 (−1.9 to −0.3) | 0.005 |
| Subgroup analyses | ||||||
| Type of ICU admission | ||||||
| Elective surgery | 451/131,450 (0.3) | 1006/245,299 (0.4) | 0.0 (−0.1 to 0.0) | 0.081 | −0.1 (−0.2 to 0.1) | 0.43 |
| Emergency surgery | 2602/32,059 (3.3) | 2602/83,522 (3.1) | −0.2 (−0.7 to 0.2) | 0.30 | −0.4 (−1.3 to 0.5) | 0.37 |
| Non-operative | 6934/73,629 (9.4) | 19,882/223,671 (8.9) | −1.1 (−1.8 to −0.5) | 0.001 | −2.1 (−3.4 to −0.8) | 0.002 |
| Noradrenaline | ||||||
| Yes | 4452/68,044 (6.5) | 10,362/121,150 (8.6) | −1.0 (−1.7 to −0.3) | 0.005 | −1.6 (−2.9 to −0.4) | 0.012 |
| No | 3,991/169,094 (2.4) | 13,128/431,342 (3.0) | −0.2 (−0.7 to 0.2) | 0.23 | −1.0 (−1.8 to −0.2) | 0.018 |
| Invasive mechanical ventilation | ||||||
| Yes | 4479/35,398 (12.7) | 12,529/76,229 (16.4) | −1.3 (−2.5 to −0.1) | 0.036 | −2.3 (−4.4 to −0.1) | 0.037 |
| No | 3,964/201,740 (2.0) | 10,961/476,263 (2.3) | −0.1 (−0.3 to 0.2) | 0.69 | −0.5 (−1.1 to 0.0) | 0.038 |
