Prolonged ICU stay: One year functional outcome and costs

Introduction: Health care cost control has encouraged examination of the benefit of care provided The long-term benefits and costs after a prolonged Surgical Intensive Care Unit (SICU) stay have not been well studied. We hypothesized that a prolonged illness requiring >7day stay in the SICU would result in significant morbidity, mortality, and hospital costs and that these findings would be long-testing. We previously reported the short-term findings (Surg Forum 48:590-592, 1997) and now extend these findings for a full year follow-up period. Methods: All patients with a length of stay (LOS) ≥ 7 days from July 1,1996- June 30,1997 in the general SICU were enrolled. 128 patients met the entry criteria and mortal status is known in 127. Functional outcome was determined at baseline, 1,3,6, and 12 months by the Sickness Impact Profile Score (SIPS), which ranges from 0-100 with a score of 30 being severely disabled. Both physical and psychological subscores were calculated. Hospital costs for the index admission and for all readmissions to JHH were obtained. Survival, SIPS scores, and charges are reported below as median values because they were not normally distributed. Scores were compared by Kruskal-Wallis (Dunn's)*p<0.05, baseline, 12 months Results: For the Index admission, the mean age was 57, and APACHE II score was 23 ± 4. Baseline 1 month 3 months 6 months 12 months Total SIPS 20.2 42.9*36.2*20.3 11.7 Phys SIPS 15.2 47.9*33.0*18.1 8.0 Psych SIPS 15.4 32.6*21.6*11.8 5.1 Survival (%) 66.1 56.7 48.8 46.4 44.8 The initial LOS in the ICU was a median of 11 days, a total of 20 ICU days and a median hospital LOS of 31 days. The index admission median cost was $ 85,806, with 65 total subsequent admissions to this facility for 774 days and a total of $1,374,392 of additional costs. In spite of the costs and morbidity and mortality of the protracted severe illness, patients surviving 12 months were both functional and happy, returning to a functional status at or improved when compared to their admission condition. Conclusions: Acute surgical illness which results in a prolonged SICU stay has a substantial in-hospital mortality and is costly, but the functional outcome from both a physical and physiologic standpoint is compatible with a good quality of life.