Abstract
BackgroundIn addition to mortality, Health Related Quality of Life (HRQOL) has increasingly been claimed as an important outcome variable. The aim of this study was to assess HRQOL and independence in activities of daily living (ADL) six months after discharge from an Intensive Care Unit (ICU), and to study its determinants.MethodsAll post-operative adult patients admitted to a surgical ICU between October 2004 and July 2005, were eligible for the study. The following variables were recorded on admission: age, gender, American Society of Anesthesiologists physical status (ASA-PS), type and magnitude of surgical procedure, ICU and hospital length of stay (LOS), mortality and Simplified Acute Physiology Score II (SAPS II). Six months after discharge, a Short Form-36 questionnaire (SF-36) and a questionnaire to assess dependency in ADL were sent to all survivors. Descriptive statistics was used to summarize data. Patient groups were compared using non-parametric tests. A logistic regression analysis was performed to identify covariate effects of each variable on dependency in personal and instrumental ADL, and for the change-in-health question of SF-36.ResultsOut of 333 hospital survivors, 226 completed the questionnaires. Fifty-nine percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients with greater co-morbidities (ASA-PS III/IV), had lower SF-36 scores in all domains and were more frequently dependent in instrumental and personal ADL. Logistic regression showed that SAPS II was associated with changes in general level of health (OR 1.06, 95%CI, 1.01 – 1.11, p = 0,016). Six months after ICU discharge, 60% and 34% of patients, respectively, were dependent in at least one activity in instrumental ADL (ADLI) and personal ADL (ADLP). ASA-PS (OR 3.00, 95%CI 1.31 – 6.87, p = 0.009) and age (OR 2.36, 95%CI, 1.04 – 5.34, p = 0.04) were associated with dependency in ADLI. For ADLP, only ASA-PS (OR 4.58, 95%CI, 1.68–12.46, p = 0.003) was associated with higher dependency.ConclusionASA-PS, age, type of surgery, ICU LOS and SAPS II could be seen as determinants of HRQOL.
Highlights
In addition to mortality, Health Related Quality of Life (HRQOL) has increasingly been claimed as an important outcome variable
American Society of Anesthesiologists physical status (ASA-PS), age, type of surgery, Intensive Care Unit (ICU) length of stay (LOS) and Simplified Acute Physiology Score II (SAPS II) could be seen as determinants of HRQOL
The following clinical variables were recorded on admission to the ICU: age, sex, body weight and height, American Society of Anesthesiologists physical status (ASA-PS)
Summary
Health Related Quality of Life (HRQOL) has increasingly been claimed as an important outcome variable. Health-related quality of life (HRQOL) is recognized as an important component of outcome evaluation among survivors and can improve the assessment of quality of life [1]. It is important to understand HRQOL in terms of specific ICU populations in order to assess the impact of specific interventions on these patients [3]. Post-operative patients are of particular interest owing to the individual risk imposed by the surgical procedure. This subset of patients may differ in important ways from the general ICU population, so a study of them may give a more accurate picture of outcome and quality of life
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