Long-term Outcomes After Sepsis In Critically Ill Surgical Patients: Discordance Between Inpatient Mortality And 1-year Outcomes
Scott Brakenridge*, Anna Gardner,* Gabriela Ghita*, Michael Cox*, Alicia Mohr*, Steven Anton*, Philip Efron*, Frederick Moore
University of Florida, Gainesville, FL
Objective(s): With early detection and treatment, inpatient sepsis mortality has decreased substantially. However, an increasing number of early sepsis survivors now progress into chronic critical illness (CCI; an ICU LOS≥14 days with persistent organ dysfunction) and their post-discharge outcomes are poorly documented. We sought to determine the long-term functional outcomes and mortality of CCI patients after surgical sepsis. Methods: We performed a prospective, longitudinal (1-year) cohort study of critically ill surgical patients with sepsis. Results: We enrolled 287 consecutive surgical patients with sepsis. Only 13 (5%) of the patients died within 14 days, while 97 (34%) developed CCI and the remaining 177 (62%) exhibited a rapid recovery (RAP). CCI compared to RAP patients were older, had greater comorbidity burden, more severe organ dysfunction and higher incidence of secondary infections (all p<0.001). Of note, 85 (87%) CCI patients survived hospitalization, but nearly all (88%) had a “poor” discharge disposition (i.e. LTAC, SNF, hospice). Physical performance (measured by the Short Physical Performance Battery) was much worse in CCI patients at 3, 6 and 12 months (all p<0.01), functional status was poor (Figure 1A) and mortality was 41% at 12 months (Figure 1B).
Conclusions: Inpatient survival after surgical sepsis is not concordant with long-term outcomes, especially amongst patients that develop CCI. This is vital information when discussing expected outcomes of surgical patients who experience a complicated clinical course.
* By Invitation
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