Early ICU Readmissions in Resource-Limited Settings: A Prospective Multicenter Registry-based Cohort Study of Risk Factors and Outcomes in Nepal

The multicenter cohort study investigates early unplanned ICU readmissions in Nepal, focusing on incidence, risk factors, and patient outcomes. Conducted across ten hospitals participating in the Nepal ICU Registry from January 2022 to January 2024, the study included patients aged >16 years who were discharged alive from the ICU. The primary outcome was unplanned ICU readmission within 48 hours.

Among 6,532 ICU discharges, 159 patients (2.43%) were readmitted within 48 hours. Key risk factors identified were after-hours discharge (OR: 1.62, 95% CI: 1.02–2.57), clinical frailty (CFS ≥ 5, OR: 1.99, 95% CI: 1.32–3.02), severe functional dependence at discharge (MBI < 50, OR: 3.50, 95% CI: 2.23–5.68), and elevated respiratory rates at discharge. Readmitted patients had significantly longer hospital stays and higher ICU and in-hospital mortality rates.

The findings highlight modifiable risk factors for ICU readmission, emphasizing the need for improved discharge planning, post-ICU monitoring, and transitional care pathways. Given the limited resources in Nepal’s healthcare system, targeted interventions—such as structured risk assessment protocols and enhanced ward-level monitoring—could help reduce preventable readmissions and improve patient outcomes. These insights are relevant to other low- and middle-income countries facing similar healthcare challenges.