Web-based supporting materials for Evaluating the performance of Australian and New Zealand intensive care units in 2009 and 2010, by J. Kasza, J. L. Moran and P. J. Solomon Table 1: Number of patients by ICU hospital level and geographical locality. ICU geographical locality ICU level NT NSW ACT SA VIC WA NZ QLD TAS Total Rural 704 7479 0 0 6578 0 2068 4519 0 21348 Metropolitan 1449 9186 1149 1456 7992 0 599 6709 754 29294 Tertiary 0 20752 2865 7587 17801 2663 6497 10572 1850 70587 Private 0 13629 0 3729 9055 616 0 15537 0 42566 Total 2153 51046 4014 12772 41426 3279 9164 37337 2604 163795 1
var(log(smr)), assuming expected number of deaths fixed 0.00 0.05 0.10 0.15 0.20 0.25 0.05 0.10 0.15 0.20 0.25 var(log(smr)) Figure 1: Estimated variances of the log-smrs of each ICU estimated under the assumption that the expected number of deaths is fixed, plotted against the estimated variances of the log-smrs of each ICU. The line is the y = x line, and indicates that variances of the log-smrs are underestimated when the expected number of deaths is assumed to be fixed. 2
3 Table 2: Stage 1 and Stage 2 model parameter estimates. All patients in the hematologic category were non-surgical, so no parameters were estimated for the interaction of hematologic with patient surgical status. Age and APACHE III have been scaled so that coefficients correspond to 10-year/unit increases. For example, for each 10 years that age increases, the log odds of in-hospital mortality increases by 0.2352, and for each 10 units that APACHE III increases, the log odds of in-hospital mortality increases by 0.5922. For factor variables, the interpretation is the increase relative to the baseline level. For example, being an elective surgical patient, versus a non-surgical patient, decreases the log odds of in-hospital mortality by 1.48. Log odds p-value 95% CI Log odds p-value 95% CI Age 0.2352 < 0.0001 0.2165 0.2540 0.2338 < 0.0001 0.2150 0.2525 Age squared 0.0134 < 0.0001 0.0074 0.0194 0.0132 < 0.0001 0.0072 0.0192 APACHE III score 0.5922 < 0.0001 0.5662 0.6181 0.5927 < 0.0001 0.5667 0.6190 APACHE III score squared -0.0099 < 0.0001-0.0123-0.0075-0.0098 < 0.0001-0.0122-0.0074 Age APACHE III score -0.0208 < 0.0001-0.0255-0.0160-0.0205 < 0.0001-0.0253-0.0158 Gender -0.0392 0.0519-0.0787 0.0003-0.0386 0.0559-0.0781 0.0010 Patient Category
4 Table 2 continued from previous page Gastrointestinal -0.1604 0.0088-0.2803-0.0404-0.1657 0.0068-0.2857-0.0458 Metabolic -1.3120 < 0.0001-1.5375-1.0866-1.3118 < 0.0001-1.5373-1.0865 Neurologic 0.5154 < 0.0001 0.3798 0.6511 0.5173 < 0.0001 0.3818 0.6528 Respiratory 0.5605 < 0.0001 0.4691 0.6518 0.5574 < 0.0001 0.4661 0.6487 Trauma -0.6107 < 0.0001-0.8525-0.3688-0.6081 < 0.0001-0.8498-0.3663 Renal/ genitourinary -0.5210 < 0.0001-0.7300-0.3121-0.5250 < 0.0001-0.7339-0.3162 Hematologic -1.4325 < 0.0001-1.6054-1.2596-1.4228 < 0.0001-1.5958-1.2498 Patient surgical status Elective surgery -1.4800 < 0.0001-1.6290-1.3310-1.4825 < 0.0001-1.6316-1.3334 Emergency surgery -0.4517 < 0.0001-0.6173-0.2862-0.4459 < 0.0001-0.6114-0.2804 Ventilation 0.4132 < 0.0001 0.3144 0.5120 0.4115 < 0.0001 0.3129 0.5102 ICU source -0.1172 0.0043-0.1977-0.0367-0.1163 0.0046-0.1968-0.0359 Patient category APACHE III score Gastrointestinal APACHE III -0.0080 0.5436-0.0338 0.0178-0.0068 0.6068-0.0326 0.0190 Metabolic APACHE III 0.0540 0.0220 0.0078 0.1003 0.0532 0.0242 0.0069 0.0995 Neurologic APACHE III -0.0651 < 0.0001-0.0938-0.0363-0.0650 < 0.0001-0.0938-0.0363 Respiratory APACHE III -0.0700 < 0.0001-0.0931-0.0469-0.0694 < 0.0001-0.0925-0.0463 Trauma APACHE III 0.1144 < 0.0001 0.0699 0.1588 0.1135 < 0.0001 0.0691 0.1580 Renal/ genitourinary APACHE III -0.0744 0.0038-0.1248-0.0241-0.0739 0.0040-0.1242-0.0235 Hematologic APACHE III 0.1755 < 0.0001 0.1315 0.2194 0.1775 < 0.0001 0.1334 0.2215 Patient category surgical status
5 Table 2 continued from previous page Gastrointestinal Elective surgery 0.9718 < 0.0001 0.7831 1.1605 0.9720 < 0.0001 0.7834 1.1607 Gastrointestinal Emergency surgery 0.1965 0.0348 0.0140 0.3789 0.1950 0.0361 0.0126 0.3774 Metabolic Elective surgery 1.3411 0.0013 0.5231 2.1592 1.3072 0.0022 0.4716 2.1429 Metabolic Emergency surgery -0.2544 0.7408-1.7614 1.2527-0.3019 0.6974-1.8237 1.2198 Neurologic Elective surgery 0.4580 < 0.0001 0.2099 0.7061 0.4992 < 0.0001 0.2508 0.7476 Neurologic Emergency surgery 0.4593 < 0.0001 0.2596 0.6590 0.4586 < 0.0001 0.2590 0.6582 Respiratory Elective surgery 0.4595 < 0.0001 0.2210 0.6980 0.4589 < 0.0001 0.2202 0.6977 Respiratory Emergency surgery -0.0600 0.6708-0.3368 0.2168-0.0588 0.6770-0.3356 0.2179 Trauma Elective surgery 1.2053 < 0.0001 0.6756 1.7350 1.1951 < 0.0001 0.6659 1.7243 Trauma Emergency surgery 0.3698 0.0030 0.1257 0.6139 0.3663 0.0033 0.1223 0.6103 Renal/ genitourinary Elective surgery 0.2623 0.1948-0.1342 0.6589 0.2679 0.1853-0.1285 0.6643 Renal/ genitourinary Emergency surgery -0.2044 0.3167-0.6046 0.1957-0.2065 0.3118-0.6065 0.1936 Hematologic Elective surgery (empty) (empty) Hematologic Emergency surgery (empty) (empty) Patient surgical status APACHE III score Elective surgery APACHE III 0.0327 0.0494 0.0001 0.0653 0.0330 0.0488 0.0002 0.0658 Emergency surgery APACHE III -0.0009 0.9433-0.0254 0.0239-0.0016 0.8997-0.0261 0.0229 Ventilation APACHE III score -0.0967 < 0.0001-0.1166-0.0768-0.0968 < 0.0001-0.1167-0.0769 Ventilation Patient category Ventilation Gastrointestinal 0.0244 0.7140-0.1061 0.1548 0.0259 0.6973-0.1046 0.1563 Ventilation Metabolic -0.3177 0.0198-0.5849-0.0506-0.3150 0.0208-0.5821-0.0478
6 Table 2 continued from previous page Ventilation Neurologic 0.3435 < 0.0001 0.1878 0.4992 0.3410 < 0.0001 0.1854 0.4966 Ventilation Respiratory -0.2879 < 0.0001-0.4072-0.1687-0.2857 < 0.0001-0.4049-0.1665 Ventilation Trauma 0.4147 0.0021 0.1505 0.6790 0.4181 0.0019 0.1540 0.6823 Ventilation Renal/ genitourinary 0.1613 0.2686-0.1245 0.4472 0.1611 0.2691-0.1246 0.4469 Ventilation Hematologic -0.7024 < 0.0001-0.9172-0.4876-0.7166 < 0.0001-0.9315-0.5018 Annual volume 0.0000 0.8760-0.0001 0.0002 0.0000 0.5013-0.0001 0.0002 Geographical locality Northern Territory -0.0109 0.9567-0.4035 0.3818-0.3166 0.1163-0.0785 0.0712 Australian Capital Territory 0.0054 0.9775-0.3668 0.3775-0.0500 0.7339-0.3383 0.2383 South Australia -0.0783 0.4793-0.2951 0.1386-0.1323 0.1324-0.3045 0.0400 Victoria -0.0230 0.7391-0.1583 0.1123-0.0750 0.1952-0.1886 0.0385 Western Australia -0.1149 0.5729-0.5146 0.2847-0.2115 0.1987-0.5340 0.1110 New Zealand 0.1846 0.0990-0.0347 0.4039 0.1254 0.1560-0.0478 0.2986 Queensland -0.0193 0.7809-0.1552 0.1166-0.1223 0.0387-0.2383-0.0634 Tasmania 0.0768 0.6925-0.3038 0.4574 0.0295 0.8471-0.2707 0.3297 Hospital level Rural 0.0355 0.7097-0.1514 0.2225 0.0891 0.2827-0.0734 0.2515 Metropolitan 0.0530 0.5277-0.1114 0.2174 0.0779 0.2870-0.0734 0.2213 Private -0.1025 0.2445-0.2751 0.0701-0.0971 0.2343-0.2571 0.0629 Hospital level surgical status Rural Elective surgery -0.4365 0.0043-0.7364-0.1365-0.4378 0.0042-0.7375-0.1380
7 Table 2 continued from previous page Rural Emergency surgery -0.3074 0.0014-0.4959-0.1189-0.3095 0.0013-0.4979-0.1211 Metropolitan Elective surgery -0.0595 0.5726-0.2662 0.1472-0.0557 0.5964-0.2621 0.1506 Metropolitan Emergency surgery -0.1343 0.0826-0.2859 0.0174-0.1335 0.0841-0.2849 0.0180 Private Elective surgery -0.5672 < 0.0001-0.7396-0.3947-0.5491 < 0.0001-0.7219-0.3763 Private Emergency surgery -0.4358 0.0001-0.6580-0.2137-0.4470 < 0.0001-0.6693-0.2246 Hospital level ICU source Rural ICU source -0.1798 0.1265-0.4104 0.0508-0.1946 0.0974-0.4247 0.0355 Metropolitan ICU source -0.2320 0.0031-0.3859-0.0781-0.2325 0.0031-0.3863-0.0787 Private ICU source -0.1441 0.2219-0.3754 0.0871-0.1396 0.2357-0.3703 0.0911 Intercept -2.7713 < 0.0001-2.9135-2.6291-2.721 < 0.0001-2.8443-2.5983 Random-effect parameters Estimate SE Estimate SE APACHE III coefficient variance 0.0031835 7.74 10 4 0.0031348 7.84 10 4 Intercept variance 0.0542223 0.01158 0.0271328 0.00734 Covariance of APACHE III and Intercept -0.0249955 0.02370-0.0187596 0.01879 Separate intercepts and APACHE III coefficients for potentially unusual ICUs (Stage 2 model only) Intercepts APACHE III coefficients Log odds p-value 95% CI Log odds p-value 95% CI 100-3.4701 < 0.0001-3.9109-3.0294 0.6424 < 0.0001 0.4717 0.8131 57-3.6413 < 0.0001-4.2617-3.0208 0.7384 < 0.0001 0.5212 0.9557 48-3.4918 < 0.0001-4.1032-2.8803 0.4822 < 0.0001 0.3611 0.6032
Table 2 continued from previous page 72-3.3026 < 0.0001-3.9429-2.6623 0.5547 < 0.0001 0.3972 0.7121 108-3.0452 < 0.0001-3.5209-2.5694 0.3948 < 0.0001 0.2523 0.5374 49-3.1316 < 0.0001-3.5538-2.7094 0.5489 < 0.0001 0.4622 0.6355 19-3.2824 < 0.0001-3.9574-2.8094 0.5879 < 0.0001 0.3314 0.8443 45-3.5060 < 0.0001-4.0035-3.0084 0.7152 < 0.0001 0.5982 0.8322 93-2.0473 < 0.0001-2.5652-1.5294 0.6081 < 0.0001 0.4150 0.8013 81-2.0476 < 0.0001-2.4185-1.6768 0.5104 < 0.0001 0.3787 0.6421 44-1.9800 < 0.0001-2.4387-1.5213 0.6845 < 0.0001 0.4800 0.8891 16-2.0124 < 0.0001-2.3170-1.7079 0.5958 < 0.0001 0.4931 0.6985 8