Long-term survival and functional capacity in cardiac surgery patients after prolonged intensive care
| Autor: | Marvin Leventhal, Thomas J. Ryan, Jean-Pierre Yared, Edward J. Mascha, Norman J. Starr, Bashour Ca, Mohamed Y. Rady |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Critical Care Critical Care and Intensive Care Medicine Severity of Illness Index Ventricular Function Left Direct Service Costs law.invention Coronary artery bypass surgery Quality of life Risk Factors law Intensive care Activities of Daily Living Severity of illness Humans Medicine Hospital Mortality Coronary Artery Bypass Hospital Costs Intensive care medicine Survival analysis Ohio Proportional Hazards Models Heart Valve Prosthesis Implantation business.industry Health services research Length of Stay Prognosis Survival Analysis Intensive care unit Cardiac surgery Logistic Models Treatment Outcome Multivariate Analysis Female Health Services Research business Follow-Up Studies |
| Zdroj: | Critical Care Medicine. 28:3847-3853 |
| ISSN: | 0090-3493 |
| Popis: | To determine whether hospital discharge alone represents a good outcome for patients who had prolonged intensive care after cardiac surgery by studying their postdischarge survival and functional outcome. The secondary objective is to estimate the proportion of intensive care unit (ICU) resources used by the long-stay (or = 10 initial consecutive ICU days) patients and to identify preoperative patient characteristics that are associated with a prolonged ICU stay and hospital and long-term survival.Inception cohort study.The Cleveland Clinic Foundation, a tertiary care, academic teaching institution.Cardiac surgery patients with an initial ICU stay of 10 or more consecutive days.Data were collected daily during hospitalization on every adult who underwent coronary artery bypass graft and/or valve surgery at one institution in 1993. Discharged patients who spent10 initial consecutive days in the ICU after surgery were contacted by telephone to determine vital status and functional capacity using the Duke Activity Status Index. Total ICU and total hospital direct costs were obtained for each patient.The primary outcome measurements were ICU length of stay, hospital mortality, after-surgery and postdischarge mortality and functional capacity, and relative resource utilization. Of the 2,618 cardiac surgery patients who met the inclusion criteria, 142 (5.4%) had an initial ICU length of stay of 10 or more consecutive days. Of these, 47 (33.1%) died in the hospital. Ninety-four of the 95 discharged patients were followed up (median follow-up, 30.6 months), and 44 of the 94 (46.8%) died during the follow-up period. The median Duke Activity Status Index for the 50 survivors was 26 out of a possible 58.2. The 142 long-stay patients used 50% of the total ICU days and 48% of the total ICU direct cost for all 2,618 patients.Many survivors of prolonged intensive care die soon after hospital discharge and many longer term survivors have a poor functional state. Therefore, hospital discharge is an incomplete measure of outcome for these patients, and longer follow-up is more appropriate. The relatively small number of patients who require prolonged intensive care consumes a disproportionate amount of the total ICU and total hospital direct cost. |
| Databáze: | OpenAIRE |
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