Survival and quality of life in patients with protracted recovery from cardiac surgery. Can we predict poor outcome?
Of all the 2256 adult cardiac surgical patients operated upon during a 12-month period from 1st February 1992 in three units, only 162 (7.2%) spent more than 48 h in the intensive care unit (ICU) (median 6 days, range 3-90). There were 47 deaths in ICU, 7 more before hospital discharge, and a further 10 before the study end-point of one year after surgery. All 98 1-year survivors were at home with 86 of them reporting their quality of life, on formal evaluation, to be within the reference range which we have established for a less complicated cohort of cardiac surgical patients. Prospectively collected physiological measurements were used in a mathematical model to test how well we could predict which patients will die and which of the survivors have a poor quality of life. The algorithm performs well for cardiac surgery patients with a specificity of 98%. If treatment had been withdrawn when death or poor quality of life became predictable, the maximum number of ICU bed days that could be freed was of the order of 2%. The plight of these patients is distressing, but most survive and do well and they are infrequent compared with the large majority who survive to leave hospital after a short ICU stay.
D000328:Adult; D000368:Aged; D000465:Algorithms; D002423:Cause of Death; D015331:Cohort Studies; D003422:Critical Care; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008020:Life Support Care / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009102:Multiple Organ Failure / Q000401:mortality / Q000628:therapy; D011183:Postoperative Complications / Q000401:mortality* / Q000628:therapy; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D016019:Survival Analysis