745: ARE ICU OUTCOMES BACK ON PRE-PANDEMIC TRAJECTORIES? A PERFORMANCE META-ANALYSIS OF 592 US HOSPITALS

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.