Across 5-year follow-up, nearly one-third of previously employed ARDS survivors never returned to work. Delayed return to work was associated with patient-related and intensive care unit/hospital-related factors, substantial lost earnings and a marked rise in government-funded healthcare coverage. These important consequences emphasise the need to design and evaluate vocation-based interventions to assist ARDS survivors return to work.

Objective To evaluate the time-varying relationship of annual physical, psychiatric, and quality of life status with subsequent inpatient health care resource use and estimated costs. Design 5-year longitudinal cohort study Setting 13 ICUs at four teaching hospitals Patients 138 patients surviving ≥2 years after ARDS Interventions None Measurements and Main Results Post-discharge inpatient resource use data (e.g., hospitalizations, skilled nursing, and rehabilitation facility stays) were collected via a retrospective structured interview at 2 years, with prospective collection every 4 months thereafter, until 5 years post-ARDS. Adjusted odds ratios for hospitalization and relative medians for estimated episode of care costs were calculated using marginal longitudinal two-part regression. The median (interquartile range [IQR]) number of inpatient admissions hospitalizations was 4 (2 – 8), with 114 (83%) patients reporting ≥1 hospital readmission. The median (IQR) estimated total inpatient post-discharge costs over 5 years were $58,500 ($19,700–$157,800, 90th percentile: $328,083). Better annual physical and quality of life status, but not psychiatric status, were associated with fewer subsequent hospitalizations and lower follow-up costs. For example, greater grip strength (per 6 kg) had an odds ratio (95% confidence interval) of 0.85 (0.73–1.00) for inpatient admission, with 23% lower relative median costs, 0.77 (0.69–0.87). Conclusions In a multi-site cohort of long-term ARDS survivors, better annual physical and quality of life status, but not psychiatric status, were associated with fewer hospitalizations and lower health care costs.

In this multisite study of 138 two-year survivors of ALI, 80% had one or more inpatient admission, representing a median (IQR) estimated cost $35,259 ($10,565-$81,166) per patient and $6,598,766 for the entire cohort. Hospital readmissions represented 76% of total inpatient costs, and having Medicare or Medicaid before ALI was associated with increased costs. With the aging population and increasing comorbidity, these findings have important health policy implications for the care of critically ill patients.