[Prolonged intensive care stay after abdominal surgery interventions with special reference to quality of life, occupational rehabilitation and economics].
Owing to increasing limitations on resources in health care, there is an urgent need to investigate effectiveness and efficiency of medical procedures. Therefore, we retrospectively studied the courses of 62 surgical patients who required at least 30 days of intensive care regarding mortality, long-term prognosis and quality of life. Additionally, a cost analysis was made using quality-adjusted life years (QALYs). The hospital mortality was 40.3%. The overall median survival time of discharged patients (n = 37) was 3.7 years and the calculated 3-year survival was 56.4%. The most frequent causes of death were septic complications or multiple organ failure in hospitalized patients and tumor relapses in discharged patients. In most of the surviving patients quality of life (median Gastrointestinal Quality of Life Index: 104 points) was good. About 20% of the discharged patients were able to return to work. Although extended intensive care therapy is extremely expensive (DM 68,250 per QALY), these costs are comparable with other accepted procedures in medicine (i.e. hemodialysis). Therefore, economical aspects should not be a generalized reason for withdrawing or withholding intensive care therapy.
Neipp
M
M
Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover.
Jähne
J
J
Niechzial
M
M
Pichlmayr
R
R
D018806:APACHE; D000008:Abdominal Neoplasms / Q000191:economics / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000401:mortality / Q000534:rehabilitation*; D019057:Quality-Adjusted Life Years; D012050:Rehabilitation, Vocational / Q000191:economics; D015996:Survival Rate