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Ann Thorac Surg 1997;63:128
© 1997 The Society of Thoracic Surgeons

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Invited Commentary

Invited Commentary

Division of Surgical Research, New Jersey Pacemaker and Defibrillation Evaluation Center, Inc., Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112.

See also page 124.

I have often wondered what happened to a catastrophically ill patient in the surgical critical-care unit a year or so later. Did a patient with borderline renal failure, on a ventilator, with an intraaortic balloon pump, and with confused mentation who struggled out of the hospital 3 weeks postoperatively really benefit after the acute episode had subsided? Unfortunately, except for an occasional patient, I could never find an answer to such a question. Certainly I would not gather enough information to have a specific statistical answer. It is reassuring to know, therefore, that many patients are quite satisfied with their lot 1 or 2 years later.

I am less pleased with the conclusions than are Söderlind and associates, because there are troublesome problems. In the first place, survivors who feel moderately well, and who realize how ill they had been, are likely to say nice things in response to simple questions. Also 27 of the 100 patients who died could not provide answers to the questionnaire, nor did the 8 living patients who did not respond to the questionnaire. What would they have said?

The stratification of risk was not really pertinent to this question. What is important is the ultimate quality of life of those patients who survive, regardless of the conditions that preceded the operation. It is more relevant to relate the specific long-term outcome to the major type of postoperative complication.

One would hope that some day the investigators will pursue some unanswered questions:

1. What was the distribution of the types of problems that kept the patients in the coronary care unit, such as renal failure, neurologic deficits, pulmonary failure, ventilator support, congestive heart failure, and myocardial infarction?
   
2. Of these groups, which were most and the least likely to have satisfactory long-term benefits?
   
3. Why did the 27 patients die, and into which categories did they fall?
   
4. How many patients had additional hospitalizations or subsequent interventions?
   
5. What additional drug therapy, if any, was needed?
   
6. What will be the patients' attitudes at 3 years, 5 years, and 10 years?
   

This report represents a beginning in answering these questions. Söderlind and associates are to be thanked for leading the way.

Related Article

Late Outcome and Quality of Life After Complicated Heart Operations

Kristina Söderlind, Hans Rutberg, and Christian Olin
Ann. Thorac. Surg. 1997 63: 124-128. [Abstract] [Full Text]

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Victor Parsonnet Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Parsonnet, V. Search for Related Content PubMed Articles by Parsonnet, V. Related Collections Related Article