Healthcare Utilization in Medical Intensive Care Unit Survivors with Alcohol Withdrawal
Article first published online: 3 MAY 2013
Copyright © 2013 by the Research Society on Alcoholism
Alcoholism: Clinical and Experimental Research
Volume 37, Issue 9, pages 1536–1543, September 2013
How to Cite
Clark, B. J., Keniston, A., Douglas, I. S., Beresford, T., Macht, M., Williams, A., Jones, J., Burnham, E. L. and Moss, M. (2013), Healthcare Utilization in Medical Intensive Care Unit Survivors with Alcohol Withdrawal. Alcoholism: Clinical and Experimental Research, 37: 1536–1543. doi: 10.1111/acer.12124
- Issue published online: 29 AUG 2013
- Article first published online: 3 MAY 2013
- Manuscript Accepted: 24 JAN 2013
- Manuscript Received: 4 SEP 2012
- National Institutes of Health. Grant Number: K24-HL-089223
- Alcohol Withdrawal;
- Alcohol Use Disorder;
- Intensive Care Unit;
- Dual Diagnosis
Rehospitalization is an important and costly outcome that occurs commonly in several diseases encountered in the medical intensive care unit (ICU). Although alcohol use disorders are present in 40% of ICU survivors and alcohol withdrawal is the most common alcohol-related reason for admission to an ICU, rates and predictors of rehospitalization have not been previously reported in this population.
We conducted a retrospective cohort study of medical ICU survivors with a primary or secondary discharge diagnosis of alcohol withdrawal using 2 administrative databases. The primary outcome was time to rehospitalization or death. Secondary outcomes included time to first emergency department or urgent care clinic visit in the subset of ICU survivors who were not rehospitalized. Cox proportional hazard models were adjusted for age, gender, race, homelessness, smoking, and payer source.
Of 1,178 patients discharged from the medical ICU over the study period, 468 (40%) were readmitted to the hospital and 54 (4%) died within 1 year. Schizophrenia (hazard ratio 2.23, 95% CI 1.57, 3.34, p < 0.001), anxiety disorder (hazard ratio 2.04, 95% CI 1.30, 3.32, p < 0.01), depression (hazard ratio 1.62, 95% CI 1.05, 2.40, p = 0.03), and Deyo comorbidity score ≥3 (hazard ratio 1.43, 95% CI 1.09, 1.89, p = 0.01) were significant predictors of time to death or first rehospitalization. Bipolar disorder was associated with time to first emergency department or urgent care clinic visit (hazard ratio 2.03, 95% CI 1.24, 3.62, p < 0.01) in the 656 patients who were alive and not rehospitalized within 1 year.
The presence of a psychiatric comorbidity is a significant predictor of multiple measures of unplanned healthcare utilization in medical ICU survivors with a primary or secondary discharge diagnosis of alcohol withdrawal. This finding highlights the potential importance of targeting longitudinal multidisciplinary care to patients with a dual diagnosis.