Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta-analysis to assess hospital re-admission rates following critical care admission and to explore potential re-admission risk factors. We searched the MEDLINE, Embase and CINAHL databases on 05 March 2020. Our search strategy incorporated controlled vocabulary and text words for hospital re-admission and critical illness, limited to the English language. Two reviewers independently applied eligibility criteria and assessed quality using the Newcastle Ottawa Score checklist and extracted data. The primary outcome was acute hospital re-admission in the year after critical care discharge. Of the 8851 studies screened, 87 met inclusion criteria and 41 were used within the meta-analysis. The analysis incorporated data from 3,897,597 patients and 741,664 re-admission episodes. Pooled estimates for hospital re-admission after critical illness were 16.9% (95%CI: 13.3–21.2%) at 30 days; 31.0% (95%CI: 24.3–38.6%) at 90 days; 29.6% (95%CI: 24.5–35.2%) at six months; and 53.3% (95%CI: 44.4–62.0%) at 12 months. Significant heterogeneity was observed across included studies. Three risk factors were associated with excess acute care rehospitalisation one year after discharge: the presence of comorbidities; events during initial hospitalisation (e.g. the presence of delirium and duration of mechanical ventilation); and subsequent infection after hospital discharge. Hospital re-admission is common in survivors of critical illness. Careful attention to the management of pre-existing comorbidities during transitions of care may help reduce healthcare utilisation after critical care discharge. Future research should determine if targeted interventions for at-risk critical care survivors can reduce the risk of subsequent rehospitalisation.

中文翻译：

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重症监护存活后再次入院：系统回顾和荟萃分析

危重病幸存者在出院后经常需要更多的医疗保健资源。我们进行了一项系统回顾和荟萃分析，以评估重症监护入院后的医院再入院率，并探索潜在的再入院风险因素。我们于 2020 年 3 月 5 日搜索了 MEDLINE、Embase 和 CINAHL 数据库。我们的搜索策略包括用于医院再入院和危重疾病的受控词汇和文本词，仅限于英语。两名审查员独立应用资格标准并使用纽卡斯尔渥太华评分清单和提取的数据评估质量。主要结果是重症监护出院后一年内的急性再次入院。在筛选的 8851 项研究中，87 项符合纳入标准，41 项用于荟萃分析。该分析纳入了 3,897,597 名患者和 741,664 次再次入院的数据。30 天时，危重病后再次入院的汇总估计值为 16.9%（95%CI：13.3–21.2%）；90 天时为 31.0%（95%CI：24.3–38.6%）；六个月时为 29.6%（95%CI：24.5–35.2%）；12 个月时为 53.3%（95%CI：44.4–62.0%）。在纳入的研究中观察到显着的异质性。三个风险因素与出院后一年过度急症再住院有关：合并症的存在；初次住院期间的事件（例如出现谵妄和机械通气持续时间）；以及出院后的后续感染。重症患者再次入院很常见。在护理过渡期间仔细注意预先存在的合并症的管理可能有助于减少重症监护出院后的医疗保健利用率。未来的研究应该确定针对高危重症监护幸存者的针对性干预是否可以降低随后再住院的风险。