Conclusions and Implications for Clinical Practice
The findings demonstrate that long-term survival is worse for those who
have experienced prolonged ICU LOS (23)(9), (24) (5),(22) (27), (10). Notably, mortality
is highest in the first six months to one year post-discharge,
indicating that more comprehensive follow-up and surveillance is
required in this time (5),(10), (24), (25). Follow-up
of cardiac surgery patients typically occurs 6-12 weeks post-operatively(33); however the timing of this is determined locally
and there is currently no national guidance regarding this. NHS England
advises that, upon discharge, patient care is transferred to their local
district general hospital or GP for medical review and referral for
cardiac rehabilitation services (if appropriate) (34).
Consequently, the onus falls on the GP and the patient themselves to
identify and report any complications, deficits or long-term effects of
prolonged ITU stay. The traditional approach of six week follow-up is
also not evidence-based (35) and those with a
prolonged stay in ITU are not flagged as higher risk and therefore are
not followed up more frequently nor comprehensively. The findings of
this review suggest that greater surveillance of patients with prolonged
LOS in ITU particularly in the first six months to one year is likely to
be beneficial. Mahesh et al. (10) found
prolonged ICU LOS to be an independent predictor of shorter long-term
survival and Silberman et al. (25) identified a
proportional relationship between ITU LOS and survival. Due to a lack of
good quality and statistically significant findings, it is not possible
to determine whether QoL is also adversely affected by prolonged ICU
LOS. Further research into QoL outcomes for this demographic is
undoubtedly required since, as the population continues to age, more
patients will undergo cardiac surgery and survive to discharge, making
it crucial to understand what the long-term outcomes are for those
requiring prolonged ICU LOS. Improved understanding of post-operative
QoL for cardiac surgery patients will enable clinicians to better
support informed decision making and provide realistic post-operative
expectations to patients and their families. The findings of this review
also highlight the importance of efforts to reduce LOS in ITU, such as
the implementation of ERAS programmes.