Survival and quality of life after cardiac surgery complicated by prolonged intensive care

Aim: To determine survival, factors determining survival and evaluate quality of life (QOL) after 1 year, in patients who had prolonged intensive care unit (ICU) stay after cardiac surgery. Methods: In the year 2001, 804 patients underwent various cardiac procedures utilising cardiopulmonary bypass (CPB). Eighty-nine consecutive patients requiring ICU stay of > 5 days constituted the study group, majority of these suffered from multiorgan failure (> 2 organ systems). Survival was determined in the study group after 1 year. Patients with an uncomplicated postoperative course were matched to the survivors in the study group with respect to age, gender, type of surgery, risk scores, and duration of follow-up and constituted the control group. The, Short Form Health Survey was used to assess QOL at the end of 1 year in these patients. QOL was compared between the study group and the control group and to that of general population. Results: Seventy percent of the patients in the study group suffered from failure of at least three organ systems. Mean ICU stay was 13 +/- 3 days (median nine, maximum 53). At the end of 1 year the mortality in the study group was 34%. The independent predictors of mortality were: preoperative cardiac support, lower ejection fraction, higher Parsonnet score, higher Euroscore, pulmonary complications, renal failure necessitating hemofiltration, CNS complications, and failure of three or more organ systems. The QOL was lower in the study group than the control group in all eight dimensions measured (significant in five p < 0.05): Physical function, Role physical, Vitality, Mental health, General health, and Bodily pain. Conclusion: One year mortality in patients with prolonged ICU stay after cardiac surgery remains high. Identification of risk factors will help to reduce the mortality with help of regular follow up. The QOL remains low in all dimensions especially those measuring physical aspects and pain.