Long-term quality of life after surgical intensive care admission.

OBJECTIVES

To quantify the long-term (>6 years) health-related quality of life (HRQOL) of a large cohort of patients admitted to a surgical intensive care unit (ICU). In addition, we aimed to explore the influence of different surgical classifications on long-term health status and to make comparisons with general population norms.

DESIGN

Prospective observational cohort study.

SETTING

A Dutch teaching hospital.

PATIENTS

All surviving surgical ICU patients admitted to the Dutch teaching hospital between 1995 and 2000.

MAIN OUTCOME MEASURES

Patient-reported data on HRQOL were collected with the EuroQol-6D (EQ-6D) after a mean follow-up of 8 years (range, 6-11 years). Patient characteristics, surgical classification, length of ICU stay, and survival were prospectively registered. The EQ utility scores (measured with the EQ-5D US index tariff), EQ visual analog scale scores, and prevalences of domain-specific health problems were calculated. The effect of surgical classification on EQ utility scores and EQ visual analog scale scores was assessed by multivariable generalized linear regression analysis. Logistic regression was used to explore the influence of surgical classification on domain-specific health problems. Long-term HRQOL of surgical ICU patients was compared with an age- and sex-matched general Dutch population using t test analysis.

RESULTS

Eight hundred thirty-four patients survived the ICU and were available for follow-up. In 575 patients (69%), the HRQOL was measured. For all surgical classifications combined, after 6 to 11 years, nearly half of all patients still had problems with mobility (52%), usual activity (52%), pain/discomfort (57%), and cognition (43%). Compared with the age- and sex-matched general population, HRQOL was worse, with a difference of 0.11 on the EQ utility score (range, 0-1). Oncological surgery patients had the best (EQ utility score, 0.83) and vascular patients had the worst (EQ utility score, 0.72) HRQOL. Trauma (odds ratio between 2.47-3.47) and vascular surgery (odds ratio between 2.27-5.37) patients showed significantly increased prevalences of problems in mobility, self-care, usual activities, and cognition.

CONCLUSIONS

More than 6 years after a surgical ICU admission, HRQOL of this patient population is largely reduced. 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.