Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Ann Surg. 2011 Jan;253(1):151-7. doi: 10.1097/SLA.0b013e3181ff45df.
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.
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%).
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.
重症监护病房（ICU）中外科患者的治疗存在重大弊端，这些弊端必须通过一些可接受的短期和长期结果来证明。ICU 治疗的短期效果已有充分记录。本研究的目的是量化对大量入住外科 ICU 的患者进行 10 年以上随访的长期生存率，并研究年龄、性别和基础疾病对这种长期生存的影响。
在 1995 年至 2000 年间，所有入住 St Elisabeth 医院 ICU 的外科患者的患者特征、疾病类别、APACHE II 评分和生存情况均进行前瞻性登记。出院后平均随访 8 年。使用 cox 比例风险分析对多个协变量的独立关联进行分析。
在纳入的 1822 名患者中，有 936 名（51%）在 11 年内死亡，52 名患者失访。总的 ICU 和院内死亡率分别为 11%和 16%。年龄、性别、APACHE II 评分、透析需求和手术分类与长期生存独立相关。入住 ICU 的年龄越大，死亡率越高（风险比为 1.058），而女性患者死亡的可能性较低（风险比为 0.793）。然而，入院前的疾病并不影响长期预后。在各种外科分类组中，长期死亡率在创伤组为 29%，胃肠组为 80%。在胃肠、肿瘤、普通外科和/或高龄患者中，死亡率的负面影响持续超过 5 年。与普通人群相比，死亡率增加了两倍（51%比 27%）。
在 ICU 出院后 10 年，生存率仅为 50%。在 ICU 治疗后，生存呈现出明确的模式，年龄、性别、手术分类、透析需求和 APACHE II 评分是独立的决定因素，且具有持久的影响。
