Quality of Life
Four of the 12 studies included assessment of quality of life in their research. Gaudino et al. (9), Lagercrantzet al. (27) and Barrie et al.(3) all found that quality of life was adversely affected or worse for those who had experienced prolonged LOS in ITU. From a sample of 12 patients who survived to follow-up, only four patients had a Karnofsky score >80, indicative of having regained full autonomy post-operatively. Two patients were never discharged from a rehabilitation centre and six patients, although discharged home, were highly dependent on support with their activities of daily living (ADLs). Across all time intervals over the 6-84 month follow-up period, most patients had a low Karnofsky score (<50) and a small number had intermediate scores (50-80). QoL (as measured by Karnofsky scores) did not improve over time(9). Lagercrantz et al. (27)reported higher scores, with 65% achieving >80 indicating full autonomy. However, they also demonstrated lower scores in both physical and mental domains for the study group vs their control (39.7 vs 43.6 (p=0.03) and 44.1 vs 50.8 (p=0.001)). Barrie et al .(3) assessed QoL at 3-6 months and one year time intervals. At 3-6 months the prolonged ICU stay group had greater weight loss (self-reported), greater fear of falling and deficits that were impacting their ability to drive. At one year, reported weight loss had improved but they were found to have deficits affecting their ability to carry out ADLs and limiting their walking distance. Those who underwent non-emergency cardiac surgery and had a subsequent prolonged LOS in ICU also reported higher ‘decision regret’ scores at 3-6 month and one year follow-up, compared to those who spent <5 days in ICU post-operatively. Initially the deficits affecting the ability to carry out ADLs were comparable; however by one year the QoL outcomes for the prolonged group were lower. On the other hand, Soppa et al.(28) found post-operative functional status in both Group A (ICU LOS 5-10 days) and Group B (ICU LOS >10 days) was good, with mean Karnofsky scores of 87 vs 77.3; however no comparison was made against a control or ‘normal’ LOS group. The results reported by Barrie et al. (3) should also be interpreted with some caution, due to a very small sample size (n=35) and no baseline assessment of QoL pre-operatively and, therefore, it cannot be concluded with certainty that long-term QoL was impaired as a result of a prolonged ITU stay.