Timmers Tim K, Verhofstad Michiel H J, Moons Karl G M, van Beeck Ed F, Leenen Luke P H
Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3524DA Utrecht, The Netherlands.
Arch Surg. 2011 Apr;146(4):412-8. doi: 10.1001/archsurg.2010.279. Epub 2010 Dec 20.
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.
Prospective observational cohort study.
A Dutch teaching hospital.
All surviving surgical ICU patients admitted to the Dutch teaching hospital between 1995 and 2000.
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.
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.
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.
量化一大批入住外科重症监护病房（ICU）患者的长期（>6年）健康相关生活质量（HRQOL）。此外，我们旨在探讨不同手术分类对长期健康状况的影响，并与一般人群标准进行比较。
前瞻性观察性队列研究。
一家荷兰教学医院。
1995年至2000年间入住该荷兰教学医院且存活的所有外科ICU患者。
在平均8年（范围6 - 11年）的随访后，使用欧洲五维度健康量表（EQ - 6D）收集患者报告的HRQOL数据。前瞻性记录患者特征、手术分类、ICU住院时间和存活情况。计算EQ效用得分（使用EQ - 5D美国指数关税测量）、EQ视觉模拟量表得分以及特定领域健康问题的患病率。通过多变量广义线性回归分析评估手术分类对EQ效用得分和EQ视觉模拟量表得分的影响。使用逻辑回归探索手术分类对特定领域健康问题的影响。通过t检验分析将外科ICU患者的长期HRQOL与年龄和性别匹配的荷兰一般人群进行比较。
834名患者在ICU存活并可供随访。其中575名患者（69%）进行了HRQOL测量。所有手术分类综合来看，6至11年后，近一半患者在行动能力（52%）、日常活动（52%）、疼痛/不适（57%）和认知（43%）方面仍存在问题。与年龄和性别匹配的一般人群相比，HRQOL较差，EQ效用得分相差0.11（范围0 - 1）。肿瘤外科手术患者的HRQOL最佳（EQ效用得分0.83），血管外科患者最差（EQ效用得分0.72）。创伤患者（比值比在2.47 - 3.47之间）和血管外科手术患者（比值比在2.27 - 5.37之间）在行动能力、自我护理、日常活动和认知方面出现问题的患病率显著增加。
外科ICU入院6年多后，该患者群体的HRQOL大幅下降。许多患者仍有各种健康问题，包括认知功能下降。应推进治疗以减少外科ICU幸存者与一般人群相比目前存在的健康缺陷。
