Long-term survival and quality of life of patients with prolonged postoperative intensive care unit stay: unmasking an apparent success

Mario Gaudino, Fabiana Girola, Mariantonietta Piscitelli, Lorenzo Martinelli, Amedeo Anselmi, Carmine Della Vella, Rocco Schiavello, Gianfederico Possati
Journal of Thoracic and Cardiovascular Surgery 2007, 134 (2): 465-9

OBJECTIVE: Our objective was to evaluate the long-term survival and quality of life of patients who faced a prolonged (>10 days) postoperative stay in the intensive care unit and were discharged from the hospital.

METHODS: Among 3125 consecutive patients who underwent cardiac operations in a 5-year period, we prospectively identified 57 who faced a prolonged postoperative intensive care unit stay and were discharged alive from the hospital. Patients were enrolled in a prospective follow-up protocol and evaluated every 6 to 12 months both clinically and instrumentally.

RESULTS: Mean intensive care unit stay was 34 +/- 9 days (range 11-141 days). Follow-up was complete and mean follow-up time was 71 months. Overall survival was 12 (21%) of 57, and the majority of follow-up deaths were cardiac related. Of the surviving patients, only a small minority (4/12) regained full autonomy and returned to their previous lifestyle. Risk factors for prolonged intensive care unit stay were age, New York Heart Association/Canadian Cardiovascular Society class, hypertension, diabetes, low ejection fraction, aortic surgery, preoperative renal failure, nonelective surgery, prolonged cardiopulmonary bypass time, and perioperative use of aortic counterpulsator.

CONCLUSIONS: Patients who face a prolonged postoperative intensive care unit stay and who were discharged from the hospital have a very poor long-term outcome and even worse quality of life. These data lead to a consideration of the wisdom of using heroic treatment in patients who face a prolonged postoperative intensive care unit stay in view of the dismal clinical results and enormous use of hospital and human resources.

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