Effects of prolonged intensive care unit stay on quality of life and long-term survival after transthoracic esophageal resection

Objective, There are few prospective data on the effects of prolonged intensive care unit stay on the quality of life and long-term survival of a homogeneous patient population. Therefore, the aims of this prospective study were a) to describe the quality of life in patients after having a transthoracic esophageal resection; and b) to analyze the influences of a prolonged intensive care unit stay on quality of life and survival in patients after esophageal cancer resection who survived to hospital discharge. Design: Prospective study. Setting. Medical center. Patients: The study population consisted of 109 patients undergoing a transthoracic resection for adenocarcinoma of the middistal esophagus or gastric cardia between April 1994 and February 2000. Interventions., None. Measurements and Main Results. A comparison was made between patients staying :55 days vs. :6 days in the intensive care unit and also :52 days vs. 2:14 days. Quality of life was assessed in all patients by mailed self-report questionnaires at baseline (preoperatively), at 5 wks, and at 3, 6, 9, 12, 18, 24, 30, and 36 months after surgery. Daily physical, emotional, and social functioning was assessed with the generic Medical Outcome Studies Short Form-20. Disease-specific quality of life was measured by an adapted Rotterdam Symptom Check List. Quality of life data were gathered between July 1994 and March 2003. Five of the 109 patients died in the hospital and were excluded from the analysis. All five of them were in the intensive care unit; >= 6 days. Of the remaining 104 patients, 92 provided baseline scores. The data of the 92 patients were used for the quality of life analyses. For the clinicopathologic and survival analysis, the data of 104 hospital survivors were used. Patients spent a median of 5.5 days (range 0-71) in the intensive care unit. The Medical Outcome Studies Short Form-20 and the Rotterdam Symptom Check List measurements showed no clear differences in long-term quality of life between patients after a short vs. a prolonged postoperative intensive care unit period. The median overall survival in all patients was 2.0 yrs (range 0.1-8.0). Median overall survival in patients staying in the intensive care unit <= 5 days was 1.9 yrs (range 0.3-7.4 yrs) vs. 2.7 yrs (range 0.9-7.2 yrs) in patients staying >= 6 days (p =.9, log-rank test). Median overall survival in patients staying in the intensive care unit <= 2 days was 1.7 yrs (range 1.2-2.6 yrs) vs. 2.0 yrs (range 0.2-3.8 yrs) in patients staying >= 14 days (p =.74, log-rank test). Conclusions. For patients who survived to hospital discharge after transthoracic esophagectomy, there was no difference in long-term quality of life or survival between those submitted to the intensive care unit for a short period vs. a long period.