Survival and quality of life in cardiac surgery patients with prolonged intensive care.
BACKGROUND
The clinical outcome in discharged cardiac surgery patients after prolonged postoperative intensive care needs further investigation. The aim was to study survival, functional status, and quality of life in cardiac surgery patients with more than 10 days postoperative intensive care unit stay.


METHODS
We performed a population-based study including 4,086 cardiac surgery patients and identified 141 patients who had a postoperative intensive care unit stay of more than 10 days. Data regarding patients and outcome were collected, and all discharged patients alive in May 2008, or a family member, were contacted to assemble information regarding functional status and quality of life using the Karnofsky performance scale and the Short Form-36 questionnaire.


RESULTS
Early mortality was 33%. Risk factors for early mortality were advanced age and postoperative dialysis. Survival at 1, 3, and 5 years was 62%, 56%, and 52%, respectively. Ninety-five patients were discharged from the hospital, and during a mean follow-up of 1.9 years, 62% were readmitted at least once. In discharged patients, 65% had a Karnofsky score of 80 or more. We found significantly lower physical (39.7 versus 43.6; p = 0.03), and mental (44.1 versus 50.8; p = 0.001) scores in the study group compared with a reference group.


CONCLUSIONS
Early mortality was high, especially in patients who required dialysis. However, long-term survival and functional status were encouraging. Quality of life was worse compared with the general population in both physical and mental aspects, but the difference was moderate. Extensive efforts in this patient group seem reasonable despite high resource utilization.
Lagercrantz
Emma
E
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.
Lindblom
Dan
D
Sartipy
Ulrik
U
D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery; D001018:Aortic Diseases / Q000401:mortality / Q000523:psychology / Q000601:surgery; D002315:Cardiopulmonary Bypass; D002423:Cause of Death; D015897:Comorbidity; D001026:Coronary Artery Bypass; D003422:Critical Care / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006331:Heart Diseases / Q000401:mortality / Q000523:psychology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D017567:Karnofsky Performance Status; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality* / Q000523:psychology*; D011379:Prognosis; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013548:Sweden; D014600:Utilization Review / Q000706:statistics & numerical data