Long-Term Quality of Life Lower After Surgical ICU Admission

Laurie Barclay, MD

April 22, 2011

April 22, 2011 — Long-term health-related quality of life (HRQOL) is lower after a surgical intensive care unit (ICU) admission, according to the results of a study reported in the April issue of the Archives of Surgery.

"A significant amount of resources in the ...ICU are devoted to patients with a poor prognosis, many of whom ultimately die," write Tim K. Timmers, MD, from the Department of Surgery at University Medical Center in Utrecht, the Netherlands, and colleagues. "Consequently, improvements of functional status and HRQOL of ICU patients have become important treatment goals. Accordingly, ICU research could shift focus from survival to HRQOL outcomes."

The goals of this prospective, observational cohort study were to assess HRQOL in the long term (> 6 years) among a large cohort of patients admitted to a surgical ICU and to assess the effect of different surgical classifications on long-term health status.

The investigators prospectively collected data on patient characteristics, surgical classification, length of ICU stay, and survival on all surgical ICU patients admitted to a Dutch teaching hospital between 1995 and 2000.

After a mean follow-up of 8 years (range, 6 - 11 years), all surviving patients were asked to provide patient-reported data on HRQOL using the EuroQol-6D (EQ-6D), with measurement of EQ utility scores, EQ visual analog scale scores, and prevalences of domain-specific health problems.

Multivariable generalized linear regression analysis allowed determination of the impact of surgical classification on EQ utility scores and EQ visual analog scale scores, and logistic regression was used to study the effect of surgical classification on domain-specific health problems. T-test analysis allowed comparison of long-term HRQOL of surgical ICU patients vs that of an age- and sex-matched general Dutch population.

Of 834 ICU survivors who were available for follow-up, 575 (69%) underwent HRQOL measurement. For all surgical classifications combined, nearly half of all patients had persistent problems after 6 to 11 years with mobility (52%), self-care (19%), usual activity (52%), pain/discomfort (57%), and cognition (43%). HRQOL was worse than that of the age- and sex-matched general population, with an EQ utility score difference of 0.11 (range, 0 - 1). HRQOL was best in patients who underwent oncologic surgery (EQ utility score, 0.83) and worst in patients undergoing vascular surgery (EQ utility score, 0.72). Problems in mobility, self-care, usual activities, and cognition were significantly more prevalent in trauma patients (odds ratio, between 2.47 and 3.47) and in patients who underwent vascular surgery (odds ratio, between 2.27 and 5.37).

Limitations of this study include lack of data on HRQOL before treatment in all patients, single measurement of HRQOL score, and death of half of the total study population before HRQOL could be measured.

"More than 6 years after a surgical ICU admission, HRQOL of this patient population is largely reduced," the study authors write. "Many patients still have 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."

The study authors have disclosed no relevant financial relationships.

Arch Surg. 2011;146:412-418. Abstract

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