Long-Term Survival and Quality of Life of Patients with Prolonged Intensive Care Unit Stay: Fate of the Survivors

Objectives: Prolonged ICU stay (prICULOS) is still associated with multiple complications. The aim of this study was to evaluate the long-term survival and quality of life (QoL) of patients who faced a prICULOS (>7 days) following cardiac surgery.

Methods: Overall, 1,579 consecutive patients underwent cardiac surgery in 2014. Among them, 142 (9.0%) met the inclusion criteria and were enrolled in this retrospective study. 69 patients (48.6%, Group 1) were discharged to home/rehab, while 57 (40.2%, Group 2) were shifted to external ICU. Median follow-up was 2.6 years (range: 0–5.1 years) and was available for 138 patients (97.2%). At follow-up, 84 patients (67%) were alive and 78 participated in the survey on postoperative QoL. The SF-36 questionnaire was used to evaluate QoL. Reference population was adjusted for age and gender in a ratio 1:2. Endpoints were postoperative course, all-cause mortality, and QoL.

Results: Mean ICU stay was 17.3 ± 11.8 days (range: 7–74 days). Patients in Group 2 had a significantly longer stay in ICU with an overall longer respiratory time, a higher incidence of dialysis, low cardiac output, and neurological complications. Thirty-day and 1-year mortality rates were also significantly higher in Group 2 compared to Group 1 (5.5 vs. 0% [p = 0.05] and 30.9 vs. 5.9% [p < 0.001], respectively). Risk factors based on Cox regression for late mortality were preoperative critical condition (HR: 3.80 [1.20–12.06], p = 0.023), COPD (HR: 3.25 [1.07–9.87], p = 0.038), impaired LV function (HR: 5.25 [2.10–13.15], p < 0.001), tricuspid insufficiency (HR: 5.10 [1.82–14.31], p = 0.002), postoperative neurological complications (HR: 2.70 [1.13–6.43], p = 0.025), and transfer to an external ICU (HR: 3.50 [1.42–8.63], p = 0.007). Compared with the reference German population, mental QoL was rated as equal to and physical QoL significantly worse by the study patients (mental component: 51.9 ± 8.9 vs. 50.9 ± 10.8 [p = ns] and physical component: 43.1 ± 11.5 vs. 39.4 ± 11.7 [p = 0.025], respectively).

Conclusion: In summary, a prICULOS does not necessarily mean a poor long-term outcome and a reduced QoL. However, patients transferred to an external ICU show very poor survival rates. Patients rate their QoL worse than the reference population, especially in the domains of physical health. Long-term survival is mainly affected by preoperative condition, postoperative neurological complications, and the destination of patient’s transfer.