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Original Articles: Adult Cardiac

Survival and Quality of Life in Cardiac Surgery Patients With Prolonged Intensive Care

^a Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden
^b Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

Accepted for publication September 29, 2009.

^_* Address correspondence to Dr Sartipy, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, SE-171 76, Sweden (Email: ulrik.sartipy{at}karolinska.se).

Background: The clinical outcome in discharged cardiac surgery patients after prolonged postoperative intensive care needs further investigation. The aim was to study survival, functional status, and quality of life in cardiac surgery patients with more than 10 days postoperative intensive care unit stay.

Methods: We performed a population-based study including 4,086 cardiac surgery patients and identified 141 patients who had a postoperative intensive care unit stay of more than 10 days. Data regarding patients and outcome were collected, and all discharged patients alive in May 2008, or a family member, were contacted to assemble information regarding functional status and quality of life using the Karnofsky performance scale and the Short Form-36 questionnaire.

Results: Early mortality was 33%. Risk factors for early mortality were advanced age and postoperative dialysis. Survival at 1, 3, and 5 years was 62%, 56%, and 52%, respectively. Ninety-five patients were discharged from the hospital, and during a mean follow-up of 1.9 years, 62% were readmitted at least once. In discharged patients, 65% had a Karnofsky score of 80 or more. We found significantly lower physical (39.7 versus 43.6; p = 0.03), and mental (44.1 versus 50.8; p = 0.001) scores in the study group compared with a reference group.

Conclusions: Early mortality was high, especially in patients who required dialysis. However, long-term survival and functional status were encouraging. Quality of life was worse compared with the general population in both physical and mental aspects, but the difference was moderate. Extensive efforts in this patient group seem reasonable despite high resource utilization.

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