Long-term survival after surgical intensive care admission: 50% die within 10 years

Introduction

ICU treatment of surgical patients comes along with major disadvantages that have to be justified by an acceptable short-term and long-term outcome. Short-term effects of ICU treatment have been well documented, but this is the first study to describe the long-term effect in a large cohort after surgical ICU admission on survival.

Methods

Of all surgical patients admitted to the ICU of a single hospital between 1995 and 2000, patient characteristics, disease category, APACHE II score and survival were prospectively registered. A continuous follow up until 6 to 11 years after discharge was achieved.

Results

Of the 1,822 patients included, 936 (51%) had died. Fifty-two patients were lost to follow up. Overall ICU and inhospital mortalities were 11% and 16%. Age, gender, APACHE II score and surgical diagnosis were independently associated with long-term survival. Mortality increased with age of admittance to the ICU, whereas female patients had a lower chance of dying (Figure 1). Long-term mortality rates in various surgical diagnostic groups varied between 29% for trauma and 70% for oncological patients. In gastrointestinal, oncological, general surgical and/or high-aged patients this negative effect even exceeds 5 years. In general, 10 years after ICU discharge the survival was only 50%. The mortality ratio was increased twofold in comparison with the general population.

Figure 1

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Conclusion

Survival after ICU treatment follows distinct patterns in which age, gender, surgical diagnosis and APACHE II score are independent determinants. A negative effect of an ICU stay appears to be long lasting.