Long-term Survival After Surgical Intensive Care Unit Admission
Long-term Survival After Surgical Intensive Care Unit Admission
Objective: Treatment of surgical patients in intensive care unit (ICU) comes along with major disadvantages, which have to be justified by some acceptable short- and long-term outcomes. Short-term effects of treatment in ICU have been well-documented. The aims of this study were to quantify the long-term survival of more than 10 years' follow-up of a large cohort of patients admitted to a surgical ICU and to investigate the effects of age, gender, and underlying disease on this long-term survival.
Patients/Methods: Of all surgical patients admitted to the ICU of the St Elisabeth hospital between 1995 and 2000, patient characteristics, disease category, APACHE II score, and survival were prospectively registered. A follow-up with a mean of 8 years after discharge was achieved. The independent association of multiple covariates was done using cox proportional hazard analysis.
Results: Of the 1822 patients included, 936 (51%) had died within 11 years and 52 patients were lost to follow-up. Overall ICU and in-hospital mortality were 11% and 16%, respectively. Age, gender, APACHE II score, the need for dialysis, and surgical classification were independently associated with long-term survival. Mortality increased with age of admittance to the ICU (hazard ratio, 1.058), whereas female patients had a lower chance to die (hazard ratio, 0.793). However, the preadmission disease did not influence long-term outcome. Long-term mortality rates in various surgical classification groups varied between 29% for trauma and 80% for gastrointestinal patients. In gastrointestinal, oncological, general surgical, and/or high-aged patients, a negative effect on mortality persisted beyond 5 years. The mortality ratio was increased twofold in comparison to the general population (51% vs 27%).
Conclusion: Ten years after ICU discharge, survival was only 50%. After ICU treatment, survival follows distinct patterns in which age, gender, surgical classification, the need of dialysis, and APACHE II score are independent determinants, and long lasting.
In recent years, there has been an increased focus on outcome after intensive care treatment. Disadvantages, such as complications and prolonged hospital stay for the patients, as well as the staggering costs of more extensive treatment, have to be justified by favorable, preferably long-term, outcome. It is well-known that patients continue to die at an accelerated rate after hospital discharge. In the last few decades, most studies of long-term outcome after intensive care unit (ICU) admission did not exceed a follow-up period longer than 2 years. Only 9 studies had a follow-up of 5 years. However, these studies were either conducted in the early 1980s, or contained low numbers of patients, or the study population did not distinguish between medical and surgical patients. Because intensive care medicine is still improving and is also becoming more expensive, new data on mortality are required. Moreover, the influence of patients' characteristics (such as, age and gender) and surgical classification on long-term outcome has never been addressed. This study focused on the surgical population, as it is a distinct ICU population, in both admission profile and outcome.
The aims of this study were to quantify the long-term survival, over a period of more than 10 years, of a large cohort of patients admitted to a surgical ICU and to investigate the effects of age, gender, and underlying disease on this long-term survival.
Abstract and Introduction
Abstract
Objective: Treatment of surgical patients in intensive care unit (ICU) comes along with major disadvantages, which have to be justified by some acceptable short- and long-term outcomes. Short-term effects of treatment in ICU have been well-documented. The aims of this study were to quantify the long-term survival of more than 10 years' follow-up of a large cohort of patients admitted to a surgical ICU and to investigate the effects of age, gender, and underlying disease on this long-term survival.
Patients/Methods: Of all surgical patients admitted to the ICU of the St Elisabeth hospital between 1995 and 2000, patient characteristics, disease category, APACHE II score, and survival were prospectively registered. A follow-up with a mean of 8 years after discharge was achieved. The independent association of multiple covariates was done using cox proportional hazard analysis.
Results: Of the 1822 patients included, 936 (51%) had died within 11 years and 52 patients were lost to follow-up. Overall ICU and in-hospital mortality were 11% and 16%, respectively. Age, gender, APACHE II score, the need for dialysis, and surgical classification were independently associated with long-term survival. Mortality increased with age of admittance to the ICU (hazard ratio, 1.058), whereas female patients had a lower chance to die (hazard ratio, 0.793). However, the preadmission disease did not influence long-term outcome. Long-term mortality rates in various surgical classification groups varied between 29% for trauma and 80% for gastrointestinal patients. In gastrointestinal, oncological, general surgical, and/or high-aged patients, a negative effect on mortality persisted beyond 5 years. The mortality ratio was increased twofold in comparison to the general population (51% vs 27%).
Conclusion: Ten years after ICU discharge, survival was only 50%. After ICU treatment, survival follows distinct patterns in which age, gender, surgical classification, the need of dialysis, and APACHE II score are independent determinants, and long lasting.
Introduction
In recent years, there has been an increased focus on outcome after intensive care treatment. Disadvantages, such as complications and prolonged hospital stay for the patients, as well as the staggering costs of more extensive treatment, have to be justified by favorable, preferably long-term, outcome. It is well-known that patients continue to die at an accelerated rate after hospital discharge. In the last few decades, most studies of long-term outcome after intensive care unit (ICU) admission did not exceed a follow-up period longer than 2 years. Only 9 studies had a follow-up of 5 years. However, these studies were either conducted in the early 1980s, or contained low numbers of patients, or the study population did not distinguish between medical and surgical patients. Because intensive care medicine is still improving and is also becoming more expensive, new data on mortality are required. Moreover, the influence of patients' characteristics (such as, age and gender) and surgical classification on long-term outcome has never been addressed. This study focused on the surgical population, as it is a distinct ICU population, in both admission profile and outcome.
The aims of this study were to quantify the long-term survival, over a period of more than 10 years, of a large cohort of patients admitted to a surgical ICU and to investigate the effects of age, gender, and underlying disease on this long-term survival.
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