Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
In the current issue of Critical Care Medicine, Dr. Ricksten and colleagues [1] attempt to quantitate and describe the elusive "quality of life" issues following cardiac surgical procedures. At the outset, one must acknowledge that accurate "lifestyle" assessment is a very elusive goal and represents a true interface between attempts at measuring physiologic parameters and a social science discipline. The study [1] is well done and reasonably controlled as much as possible given an extensive retrospective protocol. Forty-seven patients, all suffering from at least triple organ failure through the required intensive care unit (ICU) stay of >5 days (with a mean length of stay of 9 days), were compared with a control group matched for age, gender, and type of surgery. These patients had an otherwise uncomplicated postoperative course. The two patient groups were compared and contrasted at 1 yr following discharge with multiple "quality of life" index measurements. Dr. Ricksten and colleagues' [1] main conclusion was that the patient group sustaining multiple organ failure and requiring much longer ICU stays can be expected to have a statistically much poorer long-term outlook with respect to quality of life measured at 1 yr following discharge. This study [1] comes from Sweden, which is a heavily socialized medical system and is different in terms of demographic utilization than that which is currently found in the United States.
Although this study [1] represents a noble attempt to quantify a very evasive issue, I must, however, find some fault with the overall study design and rationale for the way the conclusions were reached, although not for the conclusions themselves. Unfortunately, the study design is all retrospective and although study patients with multiple organ failure were matched with concomitant patients in a control group being matched for age, gender, and type of surgery, no specific provision was made for true risk adjustment for these two groups. One must wonder if the length of stay, multiple organ failure, and overall complication rate were merely a "pass through" due to a higher risk-adjusted starting point for the study patients. In other words, their postoperative ICU condition both acutely and 1 yr following surgery might be more a result of their preoperative morbid condition rather than directly attributed to ICU postoperative complications. This study [1] provides well-measured indices of organ compromise and physiologic dysfunction, including the need for prolonged ventilatory, hemodynamic, or mechanical support. The Nottingham Health Profile [2] provided a generally complete overview of health-related quality of life issues, but we must acknowledge that these variables are purely in the realm of the social sciences and have many rather vague, albeit meaningful, qualities. The authors [1] do note that the preoperative Higgins' score was twice as high in the prolonged ICU study group as in the control group. The major criticism of this type of study must fall back on the fact that not enough information on the preoperative status of both the prolonged ICU multiple organ failure patient group as well as the control groups was provided in this retrospective study [1]. Both the short-term and long-term results may well be due to preoperative conditions as well as prolonged ICU stay. What is needed is not only periodic self-assessed perceptions of the state of health over time, but also a provision for performing a prospective study. Otherwise, the conclusions offered in this study [1] may merely fall in the realm of self-evident "soft" findings.
