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

Abstract

Introduction: Advances in care of the critically ill patient have promoted growth in the number of “chronically critically ill”-patients who survive acute medical crisis only to require weeks of intensive monitoring. This population accounts for a small fraction of admissions yet a disproportionately large fraction of healthcare resources. Despite this allocation, long-term outcomes are poorly understood. The goal of this study is to determine the rate of mortality in the 3 years following prolonged admission to the surgical intensive care unit. Methods: This retrospective study includes patients discharged from a twenty-bed surgical intensive care unit in an 874-bed tertiary care academic hospital. All patients who were at least 18 years old, spent at least 30 consecutive days in the surgical intensive care unit, and were discharged during 2002-2009 were eligible for inclusion in the study. Patients were followed for 3 years following discharge. Age, sex, length of hospital stay, length of surgical intensive care unit stay, and admitting diagnosis were abstracted from medical records. For living patients, ventilator-dependence at discharge and disposition to rehabilitation facility were documented. Date of death was determined from medical records and the Social Security Death Master File. Using a proportional hazards model, these patient variables were analyzed for their contribution to mortality during admission as well as at 1 year and 3 years post discharge. Results: Sixty-four patients were included in the study: 35 males and 29 females with a mean age of 59 (21 - 83) years, surgical intensive care unit stay of 47 (30 - 125) days, and hospital stay of 58 (30 - 178) days. Thirty patients died during admission, 16 died within 1 year of discharge, and an additional 4 patients died within 3 years. Among those discharged, 70% of deaths occurred within 3 months. No variables were identified as independent risk factors for mortality. Conclusions: An increasing number of patients are admitted for prolonged stays in the surgical intensive care unit. The human cost of prolonged surgical intensive care unit admission is high with 70% of patients succumbing during admission or within the first year after discharge.