Survival and functional outcome after prolonged intensive care unit stay

Objective To examine the functional outcome and costs of a prolonged illness requirin g a stay in the surgical intensive care unit (SICU) of 7 of more days. Summary Background Data The long-term benefits and costs after a prolonged SICU stay have not been well studied. Methods All patients with an SICU length of stay of 7 or more days from July 1, 199 6, to June 30, 1997, were enrolled. One hundred twenty-eight patients mel t he entry criteria, and mortality status was known in 127. Functional outcom e was determined at baseline and at 1, 3, 6, and 12 months using the Sickne ss Impact Profile score, which ranges from 0 to 100, with a score of 30 bei ng severely disabled. Hospital costs for the index admission and for all re admissions to Johns Hopkins Hospital were obtained. All data are reported a s median values. Results For the index admission, age was 57 and APACHE II score was 23. The initial length of stay in the ICU was 11 days; the hospital length of stay was 31 days. The Sickness impact Profile score was 20.2 at baseline, 42.9 at 1 mon th, 36.2 at 3 months, and 20.3 at 6 months, and was lower than baseline at 1 year. The actual 1-year survival rate was 45.3%. The index admission medi an cost was $85,806, with 65 total subsequent admissions to this facility. The cost for a single 1-year survivor was $282,618 (1996). Conclusions An acute surgical illness that results in a prolonged SICU stay has a subst antial in-hospital death rate and is costly, but the functional outcome fro m both a physical and physiologic standpoint is compatible with a good qual ity of life.