Health Care Delivery

Use of mechanical ventilation in adult noncardiac surgery patients increased in Ontario during the 1990s

In Ontario, Canada, during the 1990s, there was a small but important increase in the number of noncardiac surgery adult patients on mechanical ventilation, according to a recent study. The study, which was supported in part by the Agency for Healthcare Research and Quality (HS11902), also found an increase in the mortality rate among these patients over the same period. For the study, Peter J. Pronovost, M.D., Ph.D., of Johns Hopkins University, and his colleagues from the University of Toronto and the Institute for Clinical Evaluative Sciences in Toronto, analyzed administrative data on 150,755 patients who received mechanical ventilation at hospitals in Ontario, Canada, between 1992 and 2000.

The researchers examined incidence of mechanical ventilation, 30-day patient mortality rate, and number of mechanical ventilation days and inpatient days. During this period, the age- and sex-adjusted incidence of mechanical ventilation increased 9 percent and 2 percent, respectively, to 217 per 100,000 adults. The number of mechanical ventilation days and proportion of mechanically ventilated days to total inpatient bed days increased 69 percent and 30 percent, respectively, to 1.8 percent and 6.2 percent. The proportion of patients who died within 1 month of beginning mechanical ventilation increased from 27 to 32 percent. Significant predictors of 30-day mortality were calendar year, age over 80 years, having three or more coexisting illnesses, and specific diagnosis. The increase, over time, in the risk-adjusted mortality rate of mechanically ventilated patients is concerning and requires further investigation, notes Dr. Pronovost. In conclusion, he notes that as the population ages, identifying trends in use of mechanical ventilation and other intensive care unit resources will be critical in planning future health care resources.

See "Mechanical ventilation in Ontario, 1992-2000: Incidence, survival, and hospital bed utilization of noncardiac surgery adult patients," by Dale M. Needham, M.A.C.C., C.A., M.D., Susan E. Bronskill, Ph.D., William, J. Sibbald, M.D., and others, in Critical Care Medicine 32(7), pp. 1504-1509, 2004.

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