Long-term outcome and quality of life of patients requiring prolonged mechanical ventilation after cardiac surgery

Objectives: To study the long-term survival and quality of life of patients with a complicated post-operative course after cardiac surgery requiring prolonged (greater than or equal to 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 postoperative 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. (C) 2003 Elsevier B.V. All rights reserved.