Assessment of survival and quality of life after discharge from a teaching hospital general intensive care unit

Abstract

Objective: To compare the pattern of survival and quality of life (QOL) of emergency and elective patients at 6 months following discharge from an intensive care unit (ICU). Design: Prospective follow-up study. Setting: A 12 bedded general medical and surgical, tertiary referral, ICU in a teaching hospital. Patients: All patients discharged from the ICU between 1/12/94 and 31/5/95 were studied. Emergency medical and surgical admissions were compared with elective admissions, who were mainly patients undergoing cardiac surgery. Measurements and endpoints: During a 6 month period, ICU, hospital and post-hospital outcome was studied and at 6 months QOL was assessed in 115 patients using a postal, self-administered Short Form 36 (SF36) questionnaire and an independent general practitioner (GP) assessment. Severity of illness, predicted mortality and cost were assessed using standard ICU scores. Main results: 341 patients were included, 18 of whom were readmitted once and four were readmitted twice to ICU. There were 228 emergency and 113 elective admissions. Fifty three (23%) emergency admissions and five (4%) elective patients died on the ICU; a further 32 emergency patients and one elective patient died before hospital discharge. One hundred and forty three emergency and 107 elective patients were discharged from hospital. At 6 months 215 patients (109 emergency, 96 elective) were known to be alive, but 28 (20 emergency, eight elective) could not be traced. 45% of emergency and 69% of elective patients completed the SF36 questionnaire. QOL for emergency compared to elective patients was significantly worse with regards to physical functioning, vitality and general health perception. Comparison with an age and sex matched general population revealed significant deterioration in physical and social functioning, mental health, general health and vitality for emergency patients and in social functioning and mental health for elective patients. However, the majority of GPs considered that physical functioning and psychological well being were unchanged in both elective and emergency patients following this episode of critical illness. The effective cost per survivor for emergency patients was almost four times that for an elective patient. Conclusion: This study demonstrates the impact of the elective versus emergency case mix in determining survival after intensive care. Self-assessed QOL at 6 months was significantly worse for emergency patients than for elective patients with regard to physical functioning, vitality and general health. Compared to a control population, in emergency patients all SF36 domains apart from pain were significantly impaired, in elective patients social functioning and mental health had deteriorated.