SURVIVAL, QUALITY-OF-LIFE, AND CHARGES IN CRITICALLY ILL SURGICAL PATIENTS REQUIRING PROLONGED ICU STAYS

Critical care consumes a significant portion of health care costs, Alt hough there are currently increasing pressures to limit expenditures, data are not always available to allow physicians and patients to make informed therapeutic or triage decisions regarding prolonged intensiv e care unit (ICU) stays, The purpose of this study was to evaluate lon g-term outcome, quality of life, and charges in surgical patients requ iring prolonged ICU stays (> 14 days), Methods: Adults requiring over 14 days of surgical ICU care from January 1991 to September 1993 were selected from our ICU data base, Survivors to hospital discharge were evaluated for outcome and quality of life by mail survey and/or teleph one interview in addition to chart review, Results: Eighty-three patie nts spent over 14 days in the surgical ICU during the study period, Fi fty-two patients (62.6%) survived to hospital discharge, Average age w as 53 Sears, average ICU length of stay was 26 days, and average hospi tal length of stay was 50 days. Complete follow-up data were available for 39 patients (75%), Thirty of the 39 patients (77%) were alive at an average follow-up of 18 months, Long-term survival in patients over 65 years old was 67% compared with 83% for younger patients (p < 0.05 ), Seventy percent reported less than 50% functional recovery, Seventy percent were living at home and 23% were on disability, Of 11 patient s employed before discharge, five had returned to work, Eighty percent of respondents reported good to fair quality of life, and 81% stated that they would undergo critical care again, The average ICU charge wa s $51,512 per patient, and the average hospital charge was $164,019 pe r patient, The average charge to achieve one longterm survivor was $24 7,812. Conclusions: In this population, prolonged ICU stays resulted i n acceptable quality of life and a relatively high survival rate despi te significant economic investment, This study does not support withdr awal of therapy or triage decisions based solely or primarily on age o r length of ICU stay.