title: Functional status and survival after prolonged intensive care unit stay following cardiac surgery.
abstract: OBJECTIVE
  The clinical outcomes of patients discharged after prolonged postoperative intensive care unit (ICU) stay following cardiac surgery are unclear. The aim of this study was to assess survival and functional status in patients whose ICU stay exceeded 5 or 10 days in a tertiary cardiac surgical unit.
  
  
  METHODS
  Patients undergoing adult cardiac surgery between October 2008 and October 2010 who stayed in an ICU for 5-10 days (Group A) or >10 days (Group B) were studied. Demographics, operative details and postoperative data were prospectively collected. The follow-up of all patients was performed by telephone questionnaire. Functional status was assessed using the Karnofsky performance score by only one investigator for uniformity of scoring. For those patients who could not be contacted, the electronic patient records and data from the UK Office for National Statistics were reviewed to determine mortality.
  
  
  RESULTS
  Between 2008 and 2010, 2250 patients underwent adult cardiac surgery. Of these, 108 (4.7%) patients stayed >5 days (Group A, n = 53 and Group B, n = 55) in the ICU, having undergone various adult cardiac surgical procedures. The mean logistic EuroSCORE was 13 (range 1.5-86) for Group A and 16 (range 1-78) for Group B (P = 0.11). The mean ICU stay was 7 (range 6-8 days) for Group A and 21 (range 10-78 days) for Group B. Death in ICU occurred in 7 (13%) Group A patients and 11 (20%) Group B patients (P = 0.34). The median follow-up of patients who survived to the hospital discharge was 30 (range 13-38 months). Of the 90 survivors discharged from the hospital, there were 13 (25%) late deaths in Group A and 26 (47%) in Group B (P = 0.02). All survivors were contacted for the assessment of their functional status. The mean Karnofsky scores for Group A and Group B were 87 (range 70-100%) and 77.3% (range 40-100%), respectively, indicating satisfactory functional status.
  
  
  CONCLUSIONS
  Patients who have a prolonged ICU stay following cardiac surgery have high early and late mortalities. However, the functional status of the survivors is satisfactory after 1 year and beyond.
authors.affiliation: Department of Cardiac Surgery, St. George's Hospital, London, UK.
authors.forename: Gopal
authors.initials: G
authors.lastname: Soppa
authors.forename: Claudia
authors.initials: C
authors.lastname: Woodford
authors.forename: Martin
authors.initials: M
authors.lastname: Yates
authors.forename: Riyan
authors.initials: R
authors.lastname: Shetty
authors.forename: Matthew
authors.initials: M
authors.lastname: Moore
authors.forename: Oswaldo
authors.initials: O
authors.lastname: Valencia
authors.forename: Nick
authors.initials: N
authors.lastname: Fletcher
authors.forename: Marjan
authors.initials: M
authors.lastname: Jahangiri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D003325:Coronary Care Units; D003422:Critical Care; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D017741:Survivors; D062606:Tertiary Care Centers; D013997:Time Factors
keywords: Cardiac surgery; Functional status; Mortality; Prolonged intensive care unit stay