Long-term survival and quality of life of patients with prolonged postoperative intensive care unit stay: unmasking an apparent success.
OBJECTIVE
Our objective was to evaluate the long-term survival and quality of life of patients who faced a prolonged (>10 days) postoperative stay in the intensive care unit and were discharged from the hospital.


METHODS
Among 3125 consecutive patients who underwent cardiac operations in a 5-year period, we prospectively identified 57 who faced a prolonged postoperative intensive care unit stay and were discharged alive from the hospital. Patients were enrolled in a prospective follow-up protocol and evaluated every 6 to 12 months both clinically and instrumentally.


RESULTS
Mean intensive care unit stay was 34 +/- 9 days (range 11-141 days). Follow-up was complete and mean follow-up time was 71 months. Overall survival was 12 (21%) of 57, and the majority of follow-up deaths were cardiac related. Of the surviving patients, only a small minority (4/12) regained full autonomy and returned to their previous lifestyle. Risk factors for prolonged intensive care unit stay were age, New York Heart Association/Canadian Cardiovascular Society class, hypertension, diabetes, low ejection fraction, aortic surgery, preoperative renal failure, nonelective surgery, prolonged cardiopulmonary bypass time, and perioperative use of aortic counterpulsator.


CONCLUSIONS
Patients who face a prolonged postoperative intensive care unit stay and who were discharged from the hospital have a very poor long-term outcome and even worse quality of life. These data lead to a consideration of the wisdom of using heroic treatment in patients who face a prolonged postoperative intensive care unit stay in view of the dismal clinical results and enormous use of hospital and human resources.
Gaudino
Mario
M
Department of Cardiac Surgery, Catholic University, Rome, Italy. mgaudino@tiscali.it
Girola
Fabiana
F
Piscitelli
Mariantonietta
M
Martinelli
Lorenzo
L
Anselmi
Amedeo
A
Della Vella
Carmine
C
Schiavello
Rocco
R
Possati
Gianfederico
G
D000203:Activities of Daily Living; D000368:Aged; D006348:Cardiac Surgical Procedures; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate