Long-term survival and quality of life in cardiac surgical patients with prolonged intensive care unit length of stay
| Autor: | Robert N. Sladen, Robert Mahapatra, Minoo N. Kavarana, Barbara Thornton, Rachel B. Wellner, Mathew R. Williams, Mehmet C. Oz, Elizabeth A. Hartnett |
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| Rok vydání: | 2002 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Critical Care Heart Diseases Multiple Organ Failure Population law.invention Postoperative Complications Quality of life law Cause of Death Organ Dysfunction Scores Activities of Daily Living Long term survival medicine Humans Risk factor Intensive care medicine education Retrospective Studies education.field_of_study business.industry Length of Stay Hospital Charges Intensive care unit Survival Rate Cardiac operations Costs and Cost Analysis Quality of Life Female Surgery Cardiology and Cardiovascular Medicine business Surgical patients |
| Zdroj: | The Annals of Thoracic Surgery. 73:1472-1478 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/s0003-4975(02)03464-1 |
| Popis: | Patients with prolonged intensive care unit (ICU) stays after cardiac operations are labor intensive and expensive. We sought to determine whether exhaustive ICU efforts result in survival or quality-of-life benefits and whether outcome could be predicted.We retrospectively analyzed all adult cardiac surgical patients in 1998 for ICU stays more than 14 days. Data were analyzed to create multiple organ dysfunction scores (MODS, range 0 to 24) and hospital charges. Follow-up was conducted 1 and 2 years apart for survival and quality-of-life evaluation.Forty-nine patients remained in the ICU more than 14 days, comprising 3.8% of our patients but 28% of total ICU bed time. This population had a 28.5% hospital mortality, which was greater than those in the ICU less than 14 days (5.3%, p0.05). By 2 years, 22 of the 35 discharged patients were alive, 16 of whom had a normal quality of life. Patients alive at 2 years had lower MODS at day 14 than those who died (2.6 +/- 1.4 versus 5.5 +/- 3.8; p0.005) as well as lower hospital costs ($223,000 +/- $128,000 versus $306,000 +/- $128,000; p0.05). No patient with an MODS of at least 6 at day 14 survived.Patients remaining in the ICU for more than 14 days suffer a higher mortality at greater expense. A MODS at day 14 may help predict those who will not enjoy long-term survival and thus aid in the decision to terminate care. |
| Databáze: | OpenAIRE |
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