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Ann Thorac Surg 2002;73:1472-1478
© 2002 The Society of Thoracic Surgeons
a Department of Surgery, College of Physicians and Surgeons of Columbia University, New York, New York, USA
b Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, New York, USA
Accepted for publication January 21, 2002.
* Address reprint requests to Dr Williams, Surgical Arrhythmia Program, MHB 7-126, 177 Ft. Washington Blvd, New York, NY 10032 USA
e-mail: mw365{at}columbia.edu
Background. Patients with prolonged intensive care unit (ICU) stays after cardiac operations are labor intensive and expensive. We sought to determine whether exhaustive ICU efforts result in survival or quality-of-life benefits and whether outcome could be predicted.
Methods. We retrospectively analyzed all adult cardiac surgical patients in 1998 for ICU stays more than 14 days. Data were analyzed to create multiple organ dysfunction scores (MODS, range 0 to 24) and hospital charges. Follow-up was conducted 1 and 2 years apart for survival and quality-of-life evaluation.
Results. Forty-nine patients remained in the ICU more than 14 days, comprising 3.8% of our patients but 28% of total ICU bed time. This population had a 28.5% hospital mortality, which was greater than those in the ICU less than 14 days (5.3%, p < 0.05). By 2 years, 22 of the 35 discharged patients were alive, 16 of whom had a normal quality of life. Patients alive at 2 years had lower MODS at day 14 than those who died (2.6 ± 1.4 versus 5.5 ± 3.8; p < 0.005) as well as lower hospital costs ($223,000 ± $128,000 versus $306,000 ± $128,000; p < 0.05). No patient with an MODS of at least 6 at day 14 survived.
Conclusions. Patients remaining in the ICU for more than 14 days suffer a higher mortality at greater expense. A MODS at day 14 may help predict those who will not enjoy long-term survival and thus aid in the decision to terminate care.
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