Comparison of factors influencing the decision to withdraw life-sustaining treatment in intensive care unit patients after implementation of the Life-Sustaining Treatment Act in Korea
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Background: The decision to discontinue intensive care unit (ICU) treatment during the end-of-life stage has recently become a significant concern in Korea, with an observed increase in life-sustaining treatment (LST) withdrawal. There is a growing demand for evidence-based support for patients, families, and clinicians in making LST decisions. This study aimed to identify factors influencing LST decisions in ICU inpatients and to analyze their impact on healthcare utilization.Methods: In this retrospective study, we examined medical records of ICU patients with neurological disorders, infectious disorders, or cancer who were treated at a single university hospital between January 1, 2019 and July 7, 2021. Factors influencing the decision to withdraw LST were compared between those who withdrew LST and those who did not.Results: Among 54,699 hospital admissions, LST was withdrawn from 550 patients (1%). Cancer was the most common disease, followed by pneumonia, and cerebral infarction. Among patients admitted to the ICU, LST was withdrawn from 215 (withdrawal group). The withdrawal group was older (78 vs. 75 years, P=0.05) and had longer total hospital stays (16 vs. 11 days, P<0.001) and higher ICU readmission rates than control patients (ICU patients for whom LST was not withdrawn). When healthcare costs were compared, there was no significant difference in the cost of ICU stay between the two groups. The family played a crucial role in the LST decision (86% of LST decisions).Conclusions: The decision to withdraw LST of ICU patients was influenced by age, readmission, and disease category. ICU costs were similar for patients who withdrew from LST treatment and those who did not. Further research is need to help patients and families tailor LST decisions in the ICU.
Abstract
Background: The decision to discontinue intensive care unit (ICU) treatment during the end-of-life stage has recently become a significant concern in Korea, with an observed increase in life-sustaining treatment (LST) withdrawal. There is a growing demand for evidence-based support for patients, families, and clinicians in making LST decisions. This study aimed to identify factors influencing LST decisions in ICU inpatients and to analyze their impact on healthcare utilization.Methods: In this retrospective study, we examined medical records of ICU patients with neurological disorders, infectious disorders, or cancer who were treated at a single university hospital between January 1, 2019 and July 7, 2021. Factors influencing the decision to withdraw LST were compared between those who withdrew LST and those who did not.Results: Among 54,699 hospital admissions, LST was withdrawn from 550 patients (1%). Cancer was the most common disease, followed by pneumonia, and cerebral infarction. Among patients admitted to the ICU, LST was withdrawn from 215 (withdrawal group). The withdrawal group was older (78 vs. 75 years, P=0.05) and had longer total hospital stays (16 vs. 11 days, P<0.001) and higher ICU readmission rates than control patients (ICU patients for whom LST was not withdrawn). When healthcare costs were compared, there was no significant difference in the cost of ICU stay between the two groups. The family played a crucial role in the LST decision (86% of LST decisions).Conclusions: The decision to withdraw LST of ICU patients was influenced by age, readmission, and disease category. ICU costs were similar for patients who withdrew from LST treatment and those who did not. Further research is need to help patients and families tailor LST decisions in the ICU.
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