Stuck in the Unit: Three-Year Outcomes Following Prolonged Stay in the Surgical Intensive Care Unit

Abstract

Introduction: Advances in medicine coupled with an aging population promote growth of the "chronically critically ill" cohort- patients who survive an acute medical crisis only to require weeks of monitoring in intensive care units (ICU). This population accounts for a small fraction of ICU admissions and a disproportionately large fraction of healthcare resources. Despite this allocation, long-term outcomes have not been reported. Hypothesis: This study proposes that surgical ICU (SICU) length of stay is associated with increased mortality during admission and in the 3 subsequent years. Method(s): Patients =18 years old with a SICU stay of =30 consecutive days who were discharged between 2002-2009 were included in this retrospective study. Only the longest stay was considered if multiple admissions occurred during the same hospitalization. Age, sex, length of hospital stay, length of SICU stay, and admitting diagnosis were taken from medical records (MRs). For living patients, ventilator-dependence at discharge and disposition to rehabilitation facility were documented. Date of death was determined from MRs and the Social Security Death Master File. Our institutional IRB waived requirement for informed consent. Result(s): Sixty-four patients were enrolled: 35 males and 29 females with a mean age of 59 (21-83) years, SICU stay of 47 (30-125) days, and hospital stay of 58 (30-178) days. Mortality was high: 30 (47%) patients died during admission, 15 (23%) died within 1 year of admission, and 5 (8%) more died within 3 years. Among those discharged from the SICU, 70% of deaths occurred during the first 3 months after discharge. Of the 34 patients discharged from the hospital, 11 were ventilator-dependent and 20 were discharged to rehabilitation facilities. Age, sex, length of stay, and admission diagnosis were not risk factors for mortality. Conclusion(s): Mortality is high for patients with prolonged stays in the SICU. However, neither age, sex, length of hospital stay, length of SICU stay, nor admission diagnosis are independent risk factors for postdischarge mortality. To the best of our knowledge, this is the first study conducted in the United States to report mortality rates for patients with a SICU stay of =30 days.