Expenditure of resources and quality of life in critically ill patients discharged from the intensive care unit

Abstract

Objective: to determine the magnitude of the change in the perceived quality of life related with health conditions and with the administered resources, in patients discharged from the intensive care units.

Methods and material: a multicentric, concurrent cohort study was made in critically ill patients at the intensive care units (ICU) of the Hospital Universitario Clinica San Rafael, Hospital Militar Central, Hospital de San Jose, Fundacion Santa Fe de Bogotá, and Clinica del Country of Bogota, and La Fundacion Valle de Lilly of Cali, Colombia. During the period between November 2004 and October 2006, 291 patients were enrolled. The severity of their condition was assessed by means of APACHE II. The interventions performed during the first three days were assessed by means of TISS 28. The SF36 was applied with a reminder of 4 weeks in order to determine the quality of life with regard to the health condition prior to admission into the unit. It was also applied six months after discharge from the unit, in order to evaluate changes in the quality of life with regard to health in each one of eight dimensions assessed by SF36 V.2. Mortality was determined at 28 days and six months after discharge from the unit. Calculation of the sample size was made to find differences of 5 points in any of the dimensions, for dependent samples and with losses due to follow-up and mortality estimated at 15%.

Results: mortality was 11,8% at discharge from the ICU, 17,1% at 28 days, and 25% at six months. 176 patients answered the SF36 survey at six months. Clinical and statistically significant deterioration of the physical role was observed.

Nevertheless, when stratification was performed according to the type of disease due to which the patient had been admitted into the ICU, it was found that the quality of life of patients with trauma worsened with regard to all dimensions: physical function: 33.6, p (0.001); physical role: 54.5, p<(0.001); corporal pain: 47.5, p <(0.001); general health: 32.4, p < (0.001); vitality: 32.5, p <(0.001); social function: 42, p<(0.001); emotional role: 34.4 p<(0.001) and mental health: 29.1, p <(0.001). With regard to the administered resources evaluated by the TISS 28 score and averages of stay, significant differences in patients with trauma were observedwith regard to patients admitted due to diseases of medical and surgical type. Trauma patients received more intervention and therefore were more costly, but had shorter ICU stays. There were no significant differences with regard to severity between patients with diseases of medical type, surgical type and trauma.

Conclusions: In our milieu, trauma patients admitted into intensive care units show a significant clinical deterioration in their quality of life related with health, in the eight dimensions assessed six months after discharge. This period of time is considered to be enough for the stabilization of their physical and mental condition. Moreover, utilization of resources by these patients is significantly greater than that of patients with diseases of medical of surgical type. This demonstrates that, in our milieu, trauma is expensive in every sense: its initial attention demands greater use of resources; its long-term consequences with regard to quality of life are more serious, taking into account the fact that these patients are generally young people with productive capacity.