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.