Quality of life after prolonged ICU stay: preliminary results of a prospective survey in critically ill patients

Introduction

Prolonged ICU stay contributes largely to the overall ICU costs. However, only limited data are available on outcome measurement in patients with prolonged ICU stay. The aim of this prospective survey was to assess quality of life in this patient group.

Methods

During a 1-year period, patients with a length of stay (LOS) > 7 days in an interdisciplinary ICU were contacted by telephone. A structured interview was performed to determine patient satisfaction via a four-item Likert scale and quality of life using the SF-36^® health survey [1]. Norm-based SF-36^® scorings (transformed to a mean ± SD = 50 ± 10) were analysed considering patient data at admission and during the ICU stay. These data were obtained from the hospital main database. Multivariate analysis was done for identification of risk factors related to reduced quality of life, and a t test for subgroup analysis. P < 0.05 was considered significant. Data are presented as the mean ± SD.

Results

A total of 1,618 patients received ICU treatment during a 1-year period (mortality rate: 4.8%). Sixty-six patients (4.1%) with a LOS > 7 days were identified (general surgery: 34.8%, cardiac surgery: 27.3%, internal medicine: 27.3%). Age was 63.9 ± 12.7 years (63.4% of patients >60 years), SAPS score was 34.9 ± 15.7 and LOS = 33.2 ± 21.7 days. Ventilatory support was needed in 58 patients (87.9%), haemodiafiltration was performed in 12 patients (18.2%). The mortality rate 6 months after discharge was 9.1%. Fifty-five patients (91.7%) responded to the questionnaire. Patients satisfaction was high (Likert scale = 1.3 ± 0.6). SF-36^® physical and mental health components ranged from 39.1 ± 12.9 to 53.1 ± 12.4. The physical and mental component summaries (PCS and MCS) were 46.2 ± 9.0 and 49.2 ± 10.9, respectively. Multivariate analysis revealed no significant risk factor for reduced PCS and MCS. Subgroup analysis showed a trend to a decreased PCS for SAPS > 37 (P = 0.07), and MCS was significantly decreased for LOS > 33 days (P = 0.002).

Conclusion

These preliminary results indicate that prolonged ICU length of stay is associated with a high survival rate after 6 months. Quality of physical and mental health with only minor limitations can be achieved in these patients.