Published ahead of print on June 8, 2006, doi:10.1164/rccm.200505-693OC Am. J. Respir. Crit. Care Med., Volume 174, Number 5, September 2006, 538-544 A more recent version of this article appeared on September 1, 2006
Submitted on May 2, 2005 2-Year Outcomes, Health Care Use and Costs in Survivors of ARDSAngela M Cheung1*,1 Department of Medicine, University Health Network, Toronto, Ontario, Canada; Department of Health Policy and Management Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada, 2 Department of Medicine, University Health Network, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada, 3 Department of Medicine, University Health Network, Toronto, Ontario, Canada; Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada, 4 Department of Medicine, University Health Network, Toronto, Ontario, Canada, 5 Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada, 6 Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada, 7 Departments of Anaesthesia and Critical Care Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada, 8 Departments of Critical Care Medicine and Anaesthesia, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada, 9 Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Anaesthesia, Mount Sinai Hospital, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada, 10 Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada, 11 Department of Medicine and Critical Care Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada, 12 Department of Medicine, University Health Network, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada * To whom correspondence should be addressed. E-mail: angela.cheung{at}uhn.on.ca.
Rationale: Little is known about the long-term outcomes and costs of survivors of ARDS. Objectives: To describe functional and quality of life outcomes, health care utilization and costs in survivors of ARDS at 2 years after ICU discharge. Methods: We recruited a cohort of ARDS survivors from 4 academic tertiary care ICUs in Toronto and prospectively followed them from ICU admission to 2 years after ICU discharge. Measurements: Clinical and functional outcomes, health care utilization, direct medical costs. Results: Eighty-five percent of ARDS patients discharged from the ICU survived to two years; overall 2-year mortality was 49%. At two years, survivors continued to have exercise limitation although 65% had returned to work. There was no statistically significant improvement in health-related quality of life (HRQOL) as measured by SF-36 between 1 and 2 years, although there was a trend toward better physical role at 2 years (p=0.0586). Apart from emotional role and mental health, all other domains remained below that of the normal population. From ICU admission to 2 years after ICU discharge, the largest portion of the health care cost for an ARDS survivor was the initial hospital stay, with ICU costs accounting for 76% of these costs. After the initial hospital stay, health care costs were related to hospital readmissions and inpatient rehabilitation. Conclusions: Survivors of ARDS continued to have functional impairment and compromised HRQOL at 2 years after discharge from the ICU. Health care utilization and costs after the initial hospitalization were driven by hospital readmission and rehabilitation. Key words: intensive care units, long-term survivors; ARDS;
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