Long-term survival and quality of life in cardiac surgical patients with prolonged intensive care unit length of stay.
BACKGROUND
Patients with prolonged intensive care unit (ICU) stays after cardiac operations are labor intensive and expensive. We sought to determine whether exhaustive ICU efforts result in survival or quality-of-life benefits and whether outcome could be predicted.


METHODS
We retrospectively analyzed all adult cardiac surgical patients in 1998 for ICU stays more than 14 days. Data were analyzed to create multiple organ dysfunction scores (MODS, range 0 to 24) and hospital charges. Follow-up was conducted 1 and 2 years apart for survival and quality-of-life evaluation.


RESULTS
Forty-nine patients remained in the ICU more than 14 days, comprising 3.8% of our patients but 28% of total ICU bed time. This population had a 28.5% hospital mortality, which was greater than those in the ICU less than 14 days (5.3%, p < 0.05). By 2 years, 22 of the 35 discharged patients were alive, 16 of whom had a normal quality of life. Patients alive at 2 years had lower MODS at day 14 than those who died (2.6 +/- 1.4 versus 5.5 +/- 3.8; p < 0.005) as well as lower hospital costs ($223,000 +/- $128,000 versus $306,000 +/- $128,000; p < 0.05). No patient with an MODS of at least 6 at day 14 survived.


CONCLUSIONS
Patients remaining in the ICU for more than 14 days suffer a higher mortality at greater expense. A MODS at day 14 may help predict those who will not enjoy long-term survival and thus aid in the decision to terminate care.
Williams
Mathew R
MR
Department of Surgery and Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, New York, USA. mw365@columbia.edu
Wellner
Rachel B
RB
Hartnett
Elizabeth A
EA
Thornton
Barbara
B
Kavarana
Minoo N
MN
Mahapatra
Robert
R
Oz
Mehmet C
MC
Sladen
Robert
R
D000203:Activities of Daily Living / Q000145:classification; D000328:Adult; D002423:Cause of Death; D003365:Costs and Cost Analysis; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000191:economics / Q000401:mortality / Q000601:surgery*; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D009102:Multiple Organ Failure / Q000191:economics / Q000401:mortality*; D011183:Postoperative Complications / Q000191:economics / Q000401:mortality*; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate