Long-term survival and functional capacity in cardiac surgery patients after prolonged intensive care

Objective: To determine whether hospital discharge alone represents a good outcome for patients who had prolonged intensive care after cardiac surgery by studying their postdischarge survival and functional outcome. The secon dary objective is to estimate the proportion of intensive care unit (ICU) r esources used by the long-stay (greater than or equal to 10 initial consecu tive ICU days) patients and to identify preoperative patient characteristic s that are associated with a prolonged ICU stay and hospital and long-term survival. Design: Inception cohort study. Setting: The Cleveland Clinic Foundation, a tertiary care, academic teachin g institution. Patients: Cardiac surgery patients with an initial ICU stay of 10 or more c onsecutive days. Interventions: Data were collected daily during hospitalization on every ad ult who underwent coronary artery bypass graft and/or valve surgery at one institution in 1993. Discharged patients who spent >10 initial consecutive days in the ICU after surgery were contacted by telephone to determine vita l status and functional capacity using the Duke Activity Status Index, Tota l ICU and total hospital direct costs were obtained for each patient. Measurements and Main Results: The primary outcome measurements were ICU le ngth of stay, hospital mortality, after-surgery and postdischarge mortality and functional capacity, and relative resource utilization. Of the 2,618 c ardiac surgery patients who met the inclusion criteria, 142 (5.4%) had an i nitial ICU length of stay of 10 or more consecutive days. Of these, 47 (33. 1%) died in the hospital. Ninety-four of the 95 discharged patients were fo llowed up (median follow-up, 30.6 months), and 44 of the 94 (46.8%) died du ring the follow-up period. The median Duke Activity Status Index for the 50 survivors was 26 out of a possible 58.2. The 142 long-stay patients used 5 0% of the total ICU days and 48% of the total ICU direct cost for all 2,618 patients. Conclusions Many survivors of prolonged intensive care die soon after hospi tal discharge and many longer term survivors have a poor functional state. Therefore, hospital discharge is an incomplete measure of outcome far these patients, and longer follow-up is more appropriate. The relatively small n umber of patients who require prolonged intensive care consumes a dispropor tionate amount of the total ICU and total hospital direct cost.