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Eur J Cardiothorac Surg 2004;25:548-552
© 2004 Elsevier Science NL
a Department of Cardiovascular Anesthesia and Intensive Care, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132 Milano, Italy
b Department of Cardiac Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
Received 1 October 2003; received in revised form 26 November 2003; accepted 27 November 2003.
* Corresponding author. Tel.: +39-2-2643-7722; fax: +39-2-2643-7155
e-mail: pappalardo.federico{at}hsr.it
Objectives: To study the long-term survival and quality of life of patients with a complicated post-operative course after cardiac surgery requiring prolonged (
7 days) mechanical ventilation (MV), since they represent a heavy burden on hospital resources and their outcome has never been adequately evaluated. Methods: Out of 4827 consecutive cardiac surgical patients, 148 (3%) required prolonged post-operative MV: their hospital course was analysed and factors affecting prolonged MV and mortality were identified using multivariate analysis. Long-term survival was assessed using Cox proportional hazard method. Long-term (36±12 months) follow-up information was collected and quality of life was assessed by an ad hoc questionnaire. Results: Overall mortality in the study group was 45.3 versus 2% in the control population (P<0.0001). Predictors of death in the prolonged MV group were age (odds ratio, OR 1.049) and diabetes (OR 3.459). Long-term survival was significantly worse in those patients who were extubated after 21 days: 88.9 versus 70.9% at 1 year (P=0.03) and 80.9 versus 64.5% at 5 years (P=0.05). Mild or no limitation in daily living was referred by 69% of the survivors. Conclusions: The hospital mortality of patients requiring prolonged MV is high. The long-term survival of patients who are weaned from MV after 21 days is significantly lower. The great majority of the survivors can enjoy a good quality of life.
Key Words: Cardiac surgery • Mechanical ventilation • Outcome • Quality of life
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