[Outcome of long-term intensive therapy of surgery patients].
OBJECTIVE
The treatment of severely ill patients remains a medical and human challenge. The aim of the study was to determine the survival rate of patients with prolonged intensive care unit (ICU) treatment. Additionally, the somatic, psychological, and social sequelae of the survivors should be determined.


METHODS
Data of all patients who stayed for at least 30 consecutive days on a surgical ICU were evaluated with respect to age, sex, diagnosis on admission, APACHE II-Score, ISS, pre-existing diseases, therapeutic procedures, complications, organ dysfunctions, and mortality. The survivors passed a follow-up examination after 35 +/- 14 months. This included somatic, psychological, and social parameters.


RESULTS
Data of 101 patients were analysed (m/f: 78/23, mean age: 49.9 +/- 18.2 years, mean stay on ICU: 57 +/- 37 days, trauma patients: 46%). 31 subjects died on the ICU. Until the follow-up, another 24 patients deceased. Thus, the total mortality rose to 55%. Age, diagnosis on admission and severity of organ failure influenced the ICU mortality. Concerning the mortality after discharge, age, pre-existing morbidity and diagnosis on admission affected the outcome. 41 of the remaining 46 patients (89%) underwent the follow-up. Nearly half of them showed no or minor signs of impairment in any of the investigated areas. One third had severe handicaps. Trauma patients had the lowest mortality rates but showed worse results in rehabilitation.


CONCLUSIONS
The mortality after prolonged ICU-treatment is substantially higher compared to average ICU patients. However, having survived the acute phase of the illness, successful rehabilitation in somatic, psychic as well as social terms could be performed to a considerable extent. This outcome is comparable to the one of other ICU populations. The results encourage to a consequent use of all medical options.
Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Eppendorf, Martinistrasse 52, 20246 Hamburg. pajonk@uke.uni-hamburg.de
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FG
Pajonk
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A
Fischer
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C
Waydhas
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T
Bregenzer
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Schweiberer
D000328:Adult; D000368:Aged; D002423:Cause of Death; D002648:Child; D003422:Critical Care / Q000706:statistics & numerical data*; D004185:Disability Evaluation; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007239:Infections / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality*; D009369:Neoplasms / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality*; D016019:Survival Analysis; D014947:Wounds and Injuries / Q000401:mortality / Q000601:surgery*