TITLE:
Stuck in the Unit: Three-Year Outcomes Following Prolonged Stay in the Surgical Intensive Care Unit
AUTHORS:
Eileen Eggenberger, Samuel Marquez, Thu Doan, David M. Radosevich, Jeffrey G. Chipman, Kaysie L. Banton, Greg J. Beilman
KEYWORDS:
Surgery, Critical Care, Long-Term Outcomes
JOURNAL NAME:
Surgical Science,
Vol.5 No.9,
September
4,
2014
ABSTRACT: Introduction: Advances in care of the critically ill patient have
promoted growth in the number of “chronically critically ill”-patients who
survive acute medical crisis only to require weeks of intensive monitoring.
This population accounts for a small fraction of admissions yet a disproportionately
large fraction of healthcare resources. Despite this allocation, long-term
outcomes are poorly understood. The goal of this study is to determine the rate
of mortality in the 3 years following prolonged admission to the surgical
intensive care unit. Methods: This retrospective study includes patients
discharged from a twenty-bed surgical intensive care unit in an 874-bed tertiary
care academic hospital. All patients who were at least 18 years old, spent at
least 30 consecutive days in the surgical intensive care unit, and were
discharged during 2002-2009 were eligible for inclusion in the study. Patients
were followed for 3 years following discharge. Age, sex, length of hospital
stay, length of surgical intensive care unit stay, and admitting diagnosis were
abstracted from medical records. For living patients, ventilator-dependence at
discharge and disposition to rehabilitation facility were documented. Date of
death was determined from medical records and the Social Security Death Master
File. Using a proportional hazards model, these patient variables were analyzed
for their contribution to mortality during admission as well as at 1 year and 3
years post discharge. Results: Sixty-four patients were included in the study:
35 males and 29 females with a mean age of 59 (21 - 83) years, surgical
intensive care unit stay of 47 (30 - 125) days, and hospital stay of 58 (30 - 178)
days. Thirty patients died during admission, 16 died within 1 year of
discharge, and an additional 4 patients died within 3 years. Among those
discharged, 70% of deaths occurred within 3 months. No variables were
identified as independent risk factors for mortality. Conclusions: An
increasing number of patients are admitted for prolonged stays in the surgical
intensive care unit. The human cost of prolonged surgical intensive care unit
admission is high with 70% of patients succumbing during admission or within
the first year after discharge.