Cargando…
Optimizing intensive care capacity using individual length-of-stay prediction models
INTRODUCTION: Effective planning of elective surgical procedures requiring postoperative intensive care is important in preventing cancellations and empty intensive care unit (ICU) beds. To improve planning, we constructed, validated and tested three models designed to predict length of stay (LOS) i...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2007
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206463/ https://www.ncbi.nlm.nih.gov/pubmed/17389032 http://dx.doi.org/10.1186/cc5730 |
_version_ | 1782148477894000640 |
---|---|
author | Van Houdenhoven, Mark Nguyen, Duy-Tien Eijkemans, Marinus J Steyerberg, Ewout W Tilanus, Hugo W Gommers, Diederik Wullink, Gerhard Bakker, Jan Kazemier, Geert |
author_facet | Van Houdenhoven, Mark Nguyen, Duy-Tien Eijkemans, Marinus J Steyerberg, Ewout W Tilanus, Hugo W Gommers, Diederik Wullink, Gerhard Bakker, Jan Kazemier, Geert |
author_sort | Van Houdenhoven, Mark |
collection | PubMed |
description | INTRODUCTION: Effective planning of elective surgical procedures requiring postoperative intensive care is important in preventing cancellations and empty intensive care unit (ICU) beds. To improve planning, we constructed, validated and tested three models designed to predict length of stay (LOS) in the ICU in individual patients. METHODS: Retrospective data were collected from 518 consecutive patients who underwent oesophagectomy with reconstruction for carcinoma between January 1997 and April 2005. Three multivariable linear regression models for LOS, namely preoperative, postoperative and intra-ICU, were constructed using these data. Internal validation was assessed using bootstrap sampling in order to obtain validated estimates of the explained variance (r(2)). To determine the potential gain of the best performing model in day-to-day clinical practice, prospective data from a second cohort of 65 consecutive patients undergoing oesophagectomy between May 2005 and April 2006 were used in the model, and the predictive performance of the model was compared with prediction based on mean LOS. RESULTS: The intra-ICU model had an r(2 )of 45% after internal validation. Important prognostic variables for LOS included greater patient age, comorbidity, type of surgical approach, intraoperative respiratory minute volume and complications occurring within 72 hours in the ICU. The potential gain of the best model in day-to-day clinical practice was determined relative to mean LOS. Use of the model reduced the deficit number (underestimation) of ICU days by 65 and increased the excess number (overestimation) of ICU days by 23 for the cohort of 65 patients. A conservative analysis conducted in the second, prospective cohort of patients revealed that 7% more oesophagectomies could have been accommodated, and 15% of cancelled procedures could have been prevented. CONCLUSION: Patient characteristics can be used to create models that will help in predicting LOS in the ICU. This will result in more efficient use of ICU beds and fewer cancellations. |
format | Text |
id | pubmed-2206463 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2007 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-22064632008-01-19 Optimizing intensive care capacity using individual length-of-stay prediction models Van Houdenhoven, Mark Nguyen, Duy-Tien Eijkemans, Marinus J Steyerberg, Ewout W Tilanus, Hugo W Gommers, Diederik Wullink, Gerhard Bakker, Jan Kazemier, Geert Crit Care Research INTRODUCTION: Effective planning of elective surgical procedures requiring postoperative intensive care is important in preventing cancellations and empty intensive care unit (ICU) beds. To improve planning, we constructed, validated and tested three models designed to predict length of stay (LOS) in the ICU in individual patients. METHODS: Retrospective data were collected from 518 consecutive patients who underwent oesophagectomy with reconstruction for carcinoma between January 1997 and April 2005. Three multivariable linear regression models for LOS, namely preoperative, postoperative and intra-ICU, were constructed using these data. Internal validation was assessed using bootstrap sampling in order to obtain validated estimates of the explained variance (r(2)). To determine the potential gain of the best performing model in day-to-day clinical practice, prospective data from a second cohort of 65 consecutive patients undergoing oesophagectomy between May 2005 and April 2006 were used in the model, and the predictive performance of the model was compared with prediction based on mean LOS. RESULTS: The intra-ICU model had an r(2 )of 45% after internal validation. Important prognostic variables for LOS included greater patient age, comorbidity, type of surgical approach, intraoperative respiratory minute volume and complications occurring within 72 hours in the ICU. The potential gain of the best model in day-to-day clinical practice was determined relative to mean LOS. Use of the model reduced the deficit number (underestimation) of ICU days by 65 and increased the excess number (overestimation) of ICU days by 23 for the cohort of 65 patients. A conservative analysis conducted in the second, prospective cohort of patients revealed that 7% more oesophagectomies could have been accommodated, and 15% of cancelled procedures could have been prevented. CONCLUSION: Patient characteristics can be used to create models that will help in predicting LOS in the ICU. This will result in more efficient use of ICU beds and fewer cancellations. BioMed Central 2007 2007-03-27 /pmc/articles/PMC2206463/ /pubmed/17389032 http://dx.doi.org/10.1186/cc5730 Text en Copyright © 2007 Van Houdenhoven et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Van Houdenhoven, Mark Nguyen, Duy-Tien Eijkemans, Marinus J Steyerberg, Ewout W Tilanus, Hugo W Gommers, Diederik Wullink, Gerhard Bakker, Jan Kazemier, Geert Optimizing intensive care capacity using individual length-of-stay prediction models |
title | Optimizing intensive care capacity using individual length-of-stay prediction models |
title_full | Optimizing intensive care capacity using individual length-of-stay prediction models |
title_fullStr | Optimizing intensive care capacity using individual length-of-stay prediction models |
title_full_unstemmed | Optimizing intensive care capacity using individual length-of-stay prediction models |
title_short | Optimizing intensive care capacity using individual length-of-stay prediction models |
title_sort | optimizing intensive care capacity using individual length-of-stay prediction models |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206463/ https://www.ncbi.nlm.nih.gov/pubmed/17389032 http://dx.doi.org/10.1186/cc5730 |
work_keys_str_mv | AT vanhoudenhovenmark optimizingintensivecarecapacityusingindividuallengthofstaypredictionmodels AT nguyenduytien optimizingintensivecarecapacityusingindividuallengthofstaypredictionmodels AT eijkemansmarinusj optimizingintensivecarecapacityusingindividuallengthofstaypredictionmodels AT steyerbergewoutw optimizingintensivecarecapacityusingindividuallengthofstaypredictionmodels AT tilanushugow optimizingintensivecarecapacityusingindividuallengthofstaypredictionmodels AT gommersdiederik optimizingintensivecarecapacityusingindividuallengthofstaypredictionmodels AT wullinkgerhard optimizingintensivecarecapacityusingindividuallengthofstaypredictionmodels AT bakkerjan optimizingintensivecarecapacityusingindividuallengthofstaypredictionmodels AT kazemiergeert optimizingintensivecarecapacityusingindividuallengthofstaypredictionmodels |