Conclusions and Implications for Clinical Practice
The findings demonstrate that long-term survival is worse for those who have experienced prolonged ICU LOS (23)(9), (24) (5),(22) (27), (10). Notably, mortality is highest in the first six months to one year post-discharge, indicating that more comprehensive follow-up and surveillance is required in this time (5),(10), (24), (25). Follow-up of cardiac surgery patients typically occurs 6-12 weeks post-operatively(33); however the timing of this is determined locally and there is currently no national guidance regarding this. NHS England advises that, upon discharge, patient care is transferred to their local district general hospital or GP for medical review and referral for cardiac rehabilitation services (if appropriate) (34). Consequently, the onus falls on the GP and the patient themselves to identify and report any complications, deficits or long-term effects of prolonged ITU stay. The traditional approach of six week follow-up is also not evidence-based (35) and those with a prolonged stay in ITU are not flagged as higher risk and therefore are not followed up more frequently nor comprehensively. The findings of this review suggest that greater surveillance of patients with prolonged LOS in ITU particularly in the first six months to one year is likely to be beneficial. Mahesh et al. (10) found prolonged ICU LOS to be an independent predictor of shorter long-term survival and Silberman et al. (25) identified a proportional relationship between ITU LOS and survival. Due to a lack of good quality and statistically significant findings, it is not possible to determine whether QoL is also adversely affected by prolonged ICU LOS. Further research into QoL outcomes for this demographic is undoubtedly required since, as the population continues to age, more patients will undergo cardiac surgery and survive to discharge, making it crucial to understand what the long-term outcomes are for those requiring prolonged ICU LOS. Improved understanding of post-operative QoL for cardiac surgery patients will enable clinicians to better support informed decision making and provide realistic post-operative expectations to patients and their families. The findings of this review also highlight the importance of efforts to reduce LOS in ITU, such as the implementation of ERAS programmes.