Prolonged intensive care treatment of octogenarians after cardiac surgery: a reasonable economic burden?†

Abstract

Presented data propose that advanced age is correlated with a higher mortality, but not with prolonged ICU treatment or higher costs after cardiac surgery. Considering the encouraging functional status and QOL of the survivors, the financial burden caused by octogenarians is justified.

Quality of Life in Relation to Length of Intensive Care Unit Stay After Cardiac Surgery

“…The other 7 studies 3,7,9,27,28,33,34 showed similar results, with QOL considerably reduced in the prolonged ICU group, particularly in domains reflecting physical activity. In 8 of 9 studies demonstrating a deterioration in QOL, there was a higher early and late mortality.…”

“…The other 16 studies were retrospective (Table 3). 3,7,9,[25][26][27][28][29][30][31][32][33][34][35][36][37] The retrospective studies included 1,438 patients. Two studies were prospective and included 100 patients.…”

“…In 8 studies, the definition of prolonged ICU stay was >5 days. 3,26,27,29,32,33,36,37 The next most common definition was >7 days, reported in 7 studies. 4,9,25,30,31,34,36 Two studies considered ≥2 days in the ICU as prolonged.…”

“…Of these, 4 studies showed mortality was higher in patients with prolonged ICU stay. 27,30,32,36 One study demonstrated statistically significant differences in mortality at 2 years between prolonged and shorter ICU stays but not at 3 years. 35 In addition, these studies reported that good QOL outcomes were achievable in patients with prolonged ICU stay at a high financial cost.…”

“…To date, no QOL assessment tool has been designed specifically for cardiac surgery, and until this occurs, multiple QOL assessment tools should be used to provide an accurate picture of a patient's QOL, as was done in 4 retrospective studies reviewed for this study. 26,27,29,31 There are 6 cardiac risk scoring systems that estimate mortality and morbidity. 41 Risk assessment is only an estimate, and many high-risk patients do well, and some low-risk may fare worse.…”