title: Very prolonged stay in the intensive care unit after cardiac operations: early results and late survival.
abstract: BACKGROUND
  Prolonged intensive care unit (ICU) stay is a surrogate for advanced morbidity or perioperative complications, and resource utilization may become an issue. It is our policy to continue full life support in the ICU, even for patients with a seemingly grim outlook. We examined the effect of duration of ICU stay on early outcomes and late survival.
  
  
  METHODS
  Between 1993 and 2011, 6,385 patients were admitted to the ICU after cardiac surgery. Patients were grouped according to length of stay in the ICU: group 1, 2 days or less (n = 4,631; 73%); group 2, 3 to 14 days (n = 1,423; 22%); group 3, more than 14 days (n = 331; 5%). Length of stay in ICU for group 3 patients was 38 ± 24 days (range, 15 to 160; median 31). Clinical profile and outcomes were compared between groups.
  
  
  RESULTS
  Patients requiring prolonged ICU stay were older, underwent more complex surgery, had greater comorbidity, and a higher predicted operative mortality (p < 0.0001). They had a higher incidence of adverse events and increased mortality (p < 0.0001). Of the 331 group 3 patients, 60% were discharged: survival of these patients at 1, 3, and 5 years was 78%, 65%, and 52%, respectively. Operative mortality as well as late survival of discharged patients was proportional to duration of ICU stay.
  
  
  CONCLUSIONS
  Current technology enables keeping sick patients alive for extended periods of time. Nearly two thirds of patients requiring prolonged ICU leave hospital, and of these, 50% attain 5-year survival. These data support offering full and continued support even for patients requiring very prolonged ICU stay.
authors.affiliation: Department of Cardiothoracic Surgery, Shaare Zedek Medical Center affiliated with the Hebrew University of Jerusalem, Jerusalem, Israel. ssilberman@szmc.org.il
authors.forename: Shuli
authors.initials: S
authors.lastname: Silberman
authors.forename: Daniel
authors.initials: D
authors.lastname: Bitran
authors.forename: Daniel
authors.initials: D
authors.lastname: Fink
authors.forename: Rachel
authors.initials: R
authors.lastname: Tauber
authors.forename: Ofer
authors.initials: O
authors.lastname: Merin
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors