Acute and long-term survival in chronically critically ill surgical patients: a retrospective observational study

Introduction Various cohort studies have shown that acute (
short-term) mortality rates in unselected critically ill patients
may have improved during the past 15 years. Whether these benefits
also affect acute and long-term prognosis in chronically critically
ill patients is unclear, as are determinants relevant to prognosis.
Methods We conducted a retrospective analysis of data collected
from March 1993 to February 2005. A cohort of 390 consecutive
surgical patients requiring intensive care therapy for more than 28
days was analyzed. Results The intensive care unit ( ICU) survival
rate was 53.6%. Survival rates at one, three and five years were
61.8%, 44.7% and 37.0% among ICU survivors. After adjustment for
relevant covariates, acute and long-term survival rates did not
differ significantly between 1993 to 1999 and 1999 to 2005
intervals. Acute prognosis was determined by disease severity
during ICU stay and by primary diagnosis. However, only the latter
was independently associated with long-term prognosis. Advanced age
was an independent prognostic determinant of poor short-term and
long-term survival. Conclusion Acute and long-term prognosis in
chronically critically ill surgical patients has remained unchanged
throughout the past 12 years. After successful surgical
intervention and intensive care, long-term outcome is reasonably
good and is mainly determined by age and underlying disease.