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Thought Leader Session

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Aging Adult Track

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Research Snapshot Theater: Quality and Patient Safety/Epidemiology - Outcomes, Adult

Are ICU Outcomes Back on Pre-Pandemic Trajectories? A Performance Meta-Analysis of 592 US Hospitals

Sunday, March 22, 2026

11:00 AM - 12:00 PM Central Time

Location: Connections Central - RST 11

Maniraj Neupane, MD, PhD

Bryan Health, Nebraska

Disclosure(s): No relevant financial relationship(s) to disclose.
AM

Alex Mancera, MSBT

Data Scientist
National Institutes of Health Clinical Center

Disclosure information not submitted.
SW

Sarah Warner, MPH

Senior Epidemiologist
National Institute of Health

Disclosure information not submitted.
MW

Morgan Walker, MD

Senior Fellow
National Institutes of Health Clinical Center

Disclosure information not submitted.
CY

Christina Yek, MD

Staff Clinician
National Institutes of Health Clinical Center, Maryland

Disclosure information not submitted.
SS

Sadia Sarzynski, MD

Staff Clinician
National Institutes of Health Clinical Center

Disclosure information not submitted.
Roxana R. Amirahmadi, M.D. (she/her/hers)

National Institutes of Health Clinical Center, Maryland

Disclosure(s): No relevant financial relationship(s) to disclose.
MR

Mary Richert, MD

Senior Fellow
National Institutes of Health Clinical Center

Disclosure information not submitted.
EC

Emad Chisthi, BS

MSRP
UK College of Medicine-Lexington

Disclosure information not submitted.
BB

Brittany Badesch, MD

Disclosure(s): No relevant financial relationship(s) to disclose.
CD

Cumhur Demirkale, PhD

Statistician
National Institutes of Health Clinical Center

Disclosure information not submitted.
BS

Bruce Swihart, PhD

Statistician
National Institutes of Health Clinical Center

Disclosure information not submitted.
Sameer Kadri, MD, MS

National Institutes of Health Clinical Center

Disclosure information not submitted.

Introduction: Recent ICU-only data (Moin. JAMA 2025) suggest ICU survival rates have recovered to prepandemic levels, but do not consider interhospital performance variation and altered ward-ICU triage patterns since the pandemic. We determined if ICU and nonICU outcomes for 5 conditions prioritized by CMS for quality of care have recovered postpandemic relative to each hospital’s expected prepandemic trajectory.

Methods: We identified adult nonCOVID19 inpatients in US acute care hospitals in the all-payer PINC-AI database with a principal diagnosis code for acute myocardial infarction (AMI), heart failure (HF), stroke, COPD, or pneumonia in the pre (1/2018-2/2020) and caseload-adjudicated postpandemic (5/2022-5/2023) periods. We estimated postpandemic risk-standardized mortality ratios (SMR) relative to prepandemic for each hospital-diagnosis combination after controlling for case-mix, acute organ failure indicators, secular changes, seasonality and patient-level covariates. We bootstrapped 10,000 iterations to yield variances in each hospital’s monthly SMRs. A weighted linear mixed model fitted to center-level covariates yielded a prediction interval for each hospital for May 2023. Prediction intervals were then meta-analyzed to estimate a pooled SMR of post-to-pre-pandemic hospital performance for each diagnosis in subsets dichotomized by need for ICU within 2 days of admission.

Results: Of 18.2M unique nonCOVID19 inpatients at 592 hospitals, 2.5M(14%) were admitted to the ICU within 2 days of admission, 1.02M pre- and 0.5M postpandemic. For ICU patients, the increased cases of death were 11.1%(95% CI 9.9-12.2%) for AMI, 14.1%(12.6-15.5%) for HF, 4.7%(3.5-6%) for stroke, 7.7%(6.2-9.1%) for COPD, and 9.5%(8.1-11%) for pneumonia if these patients were hospitalized in May 2023 vs during the prepandemic period. Increased cases of death [10.8%(9.5-12.2%) for AMI, 9.4%(7.5-11.4%) for HF, 14.2%(12.6-15.9%) for stroke, 5%(2.9-7.1%) for COPD, 13.3%(11.4-15.3%) for pneumonia] extended to ward patients.

Conclusions: At a year beyond the pandemic, survivability for both critically ill and ward patients across all 5 CMS-prioritized conditions remains worse than their prepandemic levels. Identifying modifiable factors at the hospital, system and community levels stymieing recovery in the “new normal” could save lives.