Long-term outcome and quality of life of patients requiring prolonged mechanical ventilation after cardiac surgery.
OBJECTIVE
To study the long-term survival and quality of life of patients with a complicated post-operative course after cardiac surgery requiring prolonged (>or=7 days) mechanical ventilation (MV), since they represent a heavy burden on hospital resources and their outcome has never been adequately evaluated.


METHODS
Out of 4827 consecutive cardiac surgical patients, 148 (3%) required prolonged post-operative MV: their hospital course was analysed and factors affecting prolonged MV and mortality were identified using multivariate analysis. Long-term survival was assessed using Cox proportional hazard method. Long-term (36+/-12 months) follow-up information was collected and quality of life was assessed by an ad hoc questionnaire.


RESULTS
Overall mortality in the study group was 45.3 versus 2% in the control population (P<0.0001). Predictors of death in the prolonged MV group were age (odds ratio, OR 1.049) and diabetes (OR 3.459). Long-term survival was significantly worse in those patients who were extubated after 21 days: 88.9 versus 70.9% at 1 year (P=0.03) and 80.9 versus 64.5% at 5 years (P=0.05). Mild or no limitation in daily living was referred by 69% of the survivors.


CONCLUSIONS
The hospital mortality of patients requiring prolonged MV is high. The long-term survival of patients who are weaned from MV after 21 days is significantly lower. The great majority of the survivors can enjoy a good quality of life.
Pappalardo
Federico
F
Department of Cardiovascular Anesthesia and Intensive Care, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132 Milano, Italy. pappalardo.federico@hsr.it
Franco
Annalisa
A
Landoni
Giovanni
G
Cardano
Paola
P
Zangrillo
Alberto
A
Alfieri
Ottavio
O
D000203:Activities of Daily Living; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000534:rehabilitation*; D002423:Cause of Death; D004812:Epidemiologic Methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000534:rehabilitation*; D011183:Postoperative Complications / Q000534:rehabilitation; D011379:Prognosis; D011788:Quality of Life; D012121:Respiration, Artificial; D013997:Time Factors; D016896:Treatment Outcome