Long-term survival and quality of life of patients with prolonged postoperative intensive care unit stay: Unmasking an apparent success

• Published in: Journal of thoracic and cardiovascular surgery Vol. 134; no. 2; pp. 465 - 469
• Main Authors: Gaudino, Mario, MD, Girola, Fabiana, MD, Piscitelli, Mariantonietta, MD, Martinelli, Lorenzo, MD, Anselmi, Amedeo, MD, Della Vella, Carmine, Schiavello, Rocco, MD, Possati, Gianfederico, MD
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.08.2007; AATS/WTSA; Elsevier
• Subjects: Activities of Daily Living; Aged; Biological and medical sciences; Cardiac Surgical Procedures; Cardiothoracic Surgery; Comorbidity; Female; Follow-Up Studies; Health Services Research; Hospital Mortality; Humans; Intensive Care Units - statistics & numerical data; Intensive Care Units - utilization; Length of Stay - statistics & numerical data; Logistic Models; Male; Medical sciences; Prospective Studies; Quality of Life; Risk Factors; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; 1; ICU; intensive care unit; 18; Heart; Human; Postoperative; Prognosis; Patient; Thorax; Long term; Survival; Intensive care unit; Quality of life; Treatment; Surgery; Prolonged
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2007.04.028

Objective Our objective was to evaluate the long-term survival and quality of life of patients who faced a prolonged (>10 days) postoperative stay in the intensive care unit and were discharged from the hospital. Methods Among 3125 consecutive patients who underwent cardiac operations in a 5-year period, we prospectively identified 57 who faced a prolonged postoperative intensive care unit stay and were discharged alive from the hospital. Patients were enrolled in a prospective follow-up protocol and evaluated every 6 to 12 months both clinically and instrumentally. Results Mean intensive care unit stay was 34 ± 9 days (range 11–141 days). Follow-up was complete and mean follow-up time was 71 months. Overall survival was 12 (21%) of 57, and the majority of follow-up deaths were cardiac related. Of the surviving patients, only a small minority (4/12) regained full autonomy and returned to their previous lifestyle. Risk factors for prolonged intensive care unit stay were age, New York Heart Association/Canadian Cardiovascular Society class, hypertension, diabetes, low ejection fraction, aortic surgery, preoperative renal failure, nonelective surgery, prolonged cardiopulmonary bypass time, and perioperative use of aortic counterpulsator. Conclusions Patients who face a prolonged postoperative intensive care unit stay and who were discharged from the hospital have a very poor long-term outcome and even worse quality of life. These data lead to a consideration of the wisdom of using heroic treatment in patients who face a prolonged postoperative intensive care unit stay in view of the dismal clinical results and enormous use of hospital and human resources.