Survival and quality of life: Short-term versus long-term ventilator patients

Objective: Examine postdischarge mortality, quality of life, and charges for care for short-term (>24 and less than or equal to96 hrs of ventilation) and long-term (>96 hrs) ventilator patients. Design: Prospective longitudinal descriptive study. Setting: Posthospital discharge follow-up in homes, nursing homes, and rehabilitation centers. Patients: Intensive care unit patients who required >24 hrs of continuous in-hospital mechanical ventilation were enrolled from February 1997 through March 1999. Patients living to hospital discharge were followed for 1 yr postdischarge. Interventions: None. Measurements and Results: A total of 538 patients were studied. In-hospital mortality was 47.4%, with a 1-yr mortality rate of 64.7%; survival analysis showed that the different survival risks for short-term and long-term ventilator patients over time were not statistically significant. Long-term patients were more likely to be discharged to a nursing home (45.2%). Short-term ventilator patients had better overall quality of life at all points postdischarge. Charges to produce a long-term survivor were significantly higher than for short-term patients; on average $86,360 more charges were required to produce a long-term ventilator patient survivor for 1 yr postdischarge. Conclusions: There were no significant demographic or clinical differences between short-term and long-term ventilator patients. Our results suggest that the likelihood of need for continued care in an extended-care facility for months and the risk of death during the first year postdischarge are sufficiently common features of this population and need to be included in discussions of treatment options with patients and their families.