Long-term (>6 years) quality of life after surgical intensive care admission

Introduction

Treatment of surgical patients in the ICU, affected by severe illnesses or injuries, should be justified by an acceptable survival and long-term quality of life (QoL). The primary aim of this study was to quantify the long-term QoL (>6 years) of a large cohort of patients admitted to a surgical ICU. In addition, we aimed to explore the influence of different surgical diagnosis groups on long-term health status and to make comparisons with general population norms.

Methods

QoL was measured in all surviving surgical ICU patients admitted to a Dutch teaching hospital between 1995 and 2000. Patient-reported data on QoL were collected with the EuroQol-5D+ after a mean follow up of 8 (range 6 to 11) years. Patient characteristics, surgical diagnosis group, length of ICU stay and survival were prospectively registered. EQ-utility scores (EQ-us), EQ Visual Analogue Scales (EQ-VAS) and prevalences of domain-specific health problems were calculated. The effect of surgical diagnosis group on EQ-us/EQ-VAS was assessed by multivariable generalized linear regression analysis. Logistic regression was used to explore the influence of surgical diagnosis group on domain-specific health problems. Long-term quality of life of surgical ICU patients was compared with an age-matched and sex-matched general Dutch population using the t-test analysis.

Results

Eight hundred and thirty-four patients survived the ICU and were available for follow up. In 598 (72%) patients, the health-related QoL was measured. For all surgical groups combined, after 6 to 11 years nearly one-half of all patients still suffered from problems in the dimensions of mobility (52%), usual activity (52%), pain (57%) and cognition (43%). Compared with the age-matched and sex-matched general Dutch population, HRQoL was worse with a difference of 0.11 on the EQ utilities score (range 0 to 1). Oncological surgery patients had the best (EQ-us 0.83) and vascular patients had the worst (EQ-us 0.72) HRQoL. Trauma (odds ratio between 2.47 and 3.47) and vascular surgery (2.27 to 5.37) showed significantly increased prevalences of problems in mobility, self-care, usual activities and cognition.

Conclusions

More than 6 years after a surgical ICU admission, the QoL of this patient population is largely reduced. Many patients still suffer from a variety of health problems, including decreased cognitive functioning. Treatment advances should be made to reduce the current health deficit of surgical ICU survivors compared with the general population.