Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Introduction/Aim : Timely transfer from the intensive care unit (ICU) to the palliative care unit (PCU) improves symptom control, resource utilization, and end-of-life care quality, yet is often delayed by bed capacity and organizational constraints. While early palliative care consultation is well studied, the impact of ICU-to-PCU transfer waiting time on short- and medium-term mortality remains unclear. The aim of this study was to evaluate the relationship between PCU transfer waiting time and 90-day mortality (primary outcome) and 30-day mortality (secondary outcome) with other prognostic factors. Methods : This single-center retrospective cohort study was conducted in a tertiary Anesthesiology ICU (October 2022–May 2026). Of 2292 ICU admissions, 93 adult patients who were transferred to the PCU were included in the study. The optimal cut-off value for waiting time was determined by ROC analysis; Kaplan-Meier survival analysis and multivariable Cox regression analyses adjusted for age, sex, ICU length of stay, APACHE-II, and NLR, along with subgroup analyses, were performed. Results : In ROC analysis, a threshold of ≥ 7 days was found to be significant in predicting 90-day mortality (AUC = 0.723, 95% CI 0.620–0.826, sensitivity 65.2%, specificity 72.3%). Ninety-day mortality was 32.0% in the group with a waiting time of less than 7 days, rising to 69.8% in the group with a waiting time of ≥ 7 days (log-rank p < 0.001). In multivariable analysis, a waiting time of ≥ 7 days remained an independent predictor of 90-day mortality, irrespective of ICU length of stay (HR = 2.342, 95% CI 1.145–4.791, p = 0.020; ICU length of stay HR = 1.014, p = 0.021). Although 30-day mortality showed a significant difference in univariate Kaplan-Meier analysis (15.7% vs. 38.1%, p = 0.005), this significance was lost after multivariable adjustment (HR = 2.401, 95% CI 0.876–6.578, p = 0.088). The adverse effect of prolonged waiting time was consistent across most subgroups, but was attenuated among male and oncology patients. Conclusion : Prolonged waiting time for transfer to the PCU is associated with increased 90-day mortality, independent of traditional clinical comorbidities. Reducing ICU-PCU transfer delays may represent a modifiable target for improving patient outcomes.
Source: Research Square
Author: Seyyid Furkan KINA
Institution: Ankara Etlik City Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225316889