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Peer-reviewedCC BY-NC-NDCritical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine

Components of institution-free days as a composite outcome after critical illness: A retrospective cohort study

  • Prashanti Marella1
  • Roohallah Alizadehsani2
  • Kevin B. Laupland3
  • Samantha Keogh4
  • Felicity Edwards3
  • Kyle White3
  • Kerina Denny5
  • Stephen Whebell6
  • Sebastiaan Blank7
  • Aashish Kumar8
  • Stephen Luke9
  • Antony Attokaran10
3 more authors
  • Alexis Tabah3
  • Jayshree Lavana11
  • Mahesh Ramanan1
11 affiliations
  1. 1Intensive Care Unit, Caboolture Hospital, Caboolture, QLD, Australia
  2. 2Institute for Intelligent Systems Research and Innovation, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
  3. 3School of Medicine, Queensland University of Technology, Brisbane, QLD, Australia
  4. 4School of Midwifery and Nursing, Queensland University of Technology, Brisbane, QLD, Australia
  5. 5Intensive Care Unit, Gold Coast Health, Southport, QLD, Australia
  6. 6Intensive Care Unit, Townsville University Hospital, Douglas, QLD, Australia
  7. 7Intensive Care Unit, Cairns Hospital, Cairns, QLD, Australia
  8. 8Intensive Care Unit, Logan Hospital, Metro South Hospital and Health Service, Brisbane, Australia
  9. 9Intensive Care Unit, Mackay Hospital, Mackay, QLD, Australia
  10. 10Intensive Care Unit, Rockhampton Hospital, QLD, Australia
  11. 11Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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Abstract

Objective: To describe the components of institution-free days (IFD) after intensive care unit (ICU) admission and assess the distribution of IFD at 365 d across various admission categories.

Design: Multicentre, retrospective cohort study.

Setting: Adult patients (aged ≥18 y) admitted to 12 ICUs in Queensland from 2017 to 2020.

Main outcome measures: IFD is the primary composite outcome defined as the number of days alive and free of healthcare institution exposure. IFD is calculated by subtracting total number of days with healthcare institution exposure from 365. Distribution of IFD and its components were evaluated across four prespecified subgroups-diagnostic category, comorbidity groups, age quartiles, and remoteness of area of residence.

Results: 44 541 ICU admissions were analysed, of which 19 706 (44.2%), 17 488 (39.2%), and 7347 (16.5%) were medical, elective, and nonelective surgical admissions, respectively. The median IFD was higher for elective surgical patients as compared to nonelective surgical and medical admissions (348 d [interquartile range (IQR): 330–355] vs. 330 [IQR: 267–349] d vs. 325 [IQR: 185–349]). Hospital readmission days were the major contributor to IFD, with 60.4% of all survivors experiencing at least one hospital readmission day within 365 d. The mean hospital readmission days were highest for nonelective surgical admissions as compared to elective and medical admissions (18.5 [standard deviation (SD):18.4] vs. 13.9 [SD: 15.9] vs. 16.1 [SD: 19.2] days).

Conclusion: Hospital readmission days were the predominant contributor to institution-days and principal driver of lower IFD for ICU survivors. Medical ICU admissions had the least IFD, followed by nonelective surgical and elective surgical patients.

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Cite

BibTeXRIS
BibTeX
@article{marella2026components,
  title = {{Components of institution-free days as a composite outcome after critical illness: A retrospective cohort study}},
  author = {Prashanti Marella and Roohallah Alizadehsani and Kevin B. Laupland and Samantha Keogh and Felicity Edwards and Kyle White and Kerina Denny and Stephen Whebell and Sebastiaan Blank and Aashish Kumar and Stephen Luke and Antony Attokaran and Alexis Tabah and Jayshree Lavana and Mahesh Ramanan},
  journal = {Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine},
  year = {2026},
  month = oct,
  doi = {10.1016/j.ccrj.2026.100228},
  url = {https://europepmc.org/article/PMC/PMC13721007},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Components of institution-free days as a composite outcome after critical illness: A retrospective cohort study
AU  - Prashanti Marella
AU  - Roohallah Alizadehsani
AU  - Kevin B. Laupland
AU  - Samantha Keogh
AU  - Felicity Edwards
AU  - Kyle White
AU  - Kerina Denny
AU  - Stephen Whebell
AU  - Sebastiaan Blank
AU  - Aashish Kumar
AU  - Stephen Luke
AU  - Antony Attokaran
AU  - Alexis Tabah
AU  - Jayshree Lavana
AU  - Mahesh Ramanan
PY  - 2026
DA  - 2026/10/23
JO  - Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine
DO  - 10.1016/j.ccrj.2026.100228
UR  - https://europepmc.org/article/PMC/PMC13721007
AB  - Objective: To describe the components of institution-free days (IFD) after intensive care unit (ICU) admission and assess the distribution of IFD at 365 d across various admission categories.  Design: Multicentre, retrospective cohort study.  Setting: Adult patients (aged ≥18 y) admitted to 12 ICUs in Queensland from 2017 to 2020.  Main outcome measures: IFD is the primary composite outcome defined as the number of days alive and free of healthcare institution exposure. IFD is calculated by subtracting total number of days with healthcare institution exposure from 365. Distribution of IFD and its components were evaluated across four prespecified subgroups-diagnostic category, comorbidity groups, age quartiles, and remoteness of area of residence.  Results: 44 541 ICU admissions were analysed, of which 19 706 (44.2%), 17 488 (39.2%), and 7347 (16.5%) were medical, elective, and nonelective surgical admissions, respectively. The median IFD was higher for elective surgical patients as compared to nonelective surgical and medical admissions (348 d [interquartile range (IQR): 330–355] vs. 330 [IQR: 267–349] d vs. 325 [IQR: 185–349]). Hospital readmission days were the major contributor to IFD, with 60.4% of all survivors experiencing at least one hospital readmission day within 365 d. The mean hospital readmission days were highest for nonelective surgical admissions as compared to elective and medical admissions (18.5 [standard deviation (SD):18.4] vs. 13.9 [SD: 15.9] vs. 16.1 [SD: 19.2] days).  Conclusion: Hospital readmission days were the predominant contributor to institution-days and principal driver of lower IFD for ICU survivors. Medical ICU admissions had the least IFD, followed by nonelective surgical and elective surgical patients.
SN  - 1441-2772
SN  - 2652-9335
ER  -