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Organ support therapy in the intensive care unit and return to work: a nationwide, register-based cohort study

Signe Riddersholm| Steffen Christensen| Kristian Kragholm| Christian F. Christiansen| Bodil Steen Rasmussen
Original
Volume 44, Issue 4 / April , 2018

Pages 418 - 427

Abstract

Purpose

The association between severity of illness and ability to return to work is unclear. Therefore, we investigated return to work and associations with measures of illness severity in ICU survivors.

Methods

We conducted this cohort study using Danish registry data for the period 2005–2014 on ICU patients who were discharged alive from hospital, had an ICU length of stay (LOS) of at least 72 h, were not treated with dialysis before hospital admission and were working prior to admission. We assessed (1) the cumulative incidence (chance) of return to work (2005–2017) and receipt of social benefits after discharge from a hospital stay with ICU admission and (2) the association between organ support therapies (renal replacement therapy, cardiovascular support and mechanical ventilation), and during 2011–2014 SAPS II and ICU LOS, and return to work, using multivariable Cox regression.

Results

Among 5762 ICU survivors, 68% returned to work within 2 years after hospital discharge. Disability and sickness benefits constituted 89% of social benefits among patients not returning to work and 59% among patients withdrawing from work following an initial return to work. Mechanical ventilation (HR 0.70, 95% CI [0.65–0.77]), but not RRT (HR 0.85, 95% CI [0.71–1.02]), cardiovascular support (HR 0.93, 95% CI [0.82–1.07]) and increasing SAPS II, was associated with decreased chance of return to work. Increasing ICU LOS was also associated with a decreased chance of return to work.

Conclusions

The majority of a nationwide cohort of ICU survivors returned to work. Sick leave and receipt of disability pension were common following ICU admission. Mechanical ventilation and longer ICU LOS were associated with reduced chances of return to work.

Keywords

References

  1. Zimmerman JE, Kramer AA, Knaus WA (2013) Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Crit Care 17:R81. https://doi.org/10.1186/cc12695
    • View reference on publisher's website
    • View reference on PubMed
  2. Carson SS (2006) Outcomes of prolonged mechanical ventilation. Curr Opin Crit Care 12:405–411. https://doi.org/10.1097/01.ccx.0000244118.08753.dc
    • View reference on publisher's website
    • View reference on PubMed
  3. Carson SS, Cox CE, Holmes GM et al (2006) The changing epidemiology of mechanical ventilation: a population-based study. J Intensive Care Med 21:173–182. https://doi.org/10.1177/0885066605282784
    • View reference on publisher's website
    • View reference on PubMed
  4. Griffith DM, Salisbury L, Lee RJ et al (2017) The burden of specific symptoms reported by survivors after critical illness. Am J Respir Crit Care Med. https://doi.org/10.1164/rccm.201702-0398le
  5. Pandharipande PP, Girard TD, Jackson JC et al (2013) Long-term cognitive impairment after critical illness. N Engl J Med 369:1306–1316. https://doi.org/10.1056/NEJMoa1301372
    • View reference on publisher's website
    • View reference on PubMed
  6. Davydow DS, Desai SV, Needham DM, Bienvenu OJ (2008) Psychiatric morbidity in survivors of the acute respiratory distress syndrome: a systematic review. Psychosom Med 70:512–519. https://doi.org/10.1097/PSY.0b013e31816aa0dd
    • View reference on publisher's website
    • View reference on PubMed
  7. Davydow DS, Gifford JM, Desai SV et al (2009) Depression in general intensive care unit survivors: a systematic review. Intensive Care Med 35:796–809. https://doi.org/10.1007/s00134-009-1396-5
  8. Parker AM, Sricharoenchai T, Raparla S et al (2015) Posttraumatic stress disorder in critical illness survivors. Crit Care Med 43:1121–1129. https://doi.org/10.1097/CCM.0000000000000882
    • View reference on publisher's website
    • View reference on PubMed
  9. Nikayin S, Rabiee A, Hashem MD et al (2016) Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis. Gen Hosp Psychiatry 43:23–29. https://doi.org/10.1016/j.genhosppsych.2016.08.005
    • View reference on publisher's website
    • View reference on PubMed
  10. Wunsch H, Christiansen CF, Johansen MB et al (2014) Psychiatric diagnoses and psychoactive medication use among nonsurgical critically ill patients receiving mechanical ventilation. JAMA 311:1133. https://doi.org/10.1001/jama.2014.2137
    • View reference on publisher's website
    • View reference on PubMed
  11. Myers EA, Smith DA, Allen SR, Kaplan LJ (2016) Post-ICU syndrome. J Am Acad Physician Assist 29:34–37. https://doi.org/10.1097/01.JAA.0000481401.21841.32
    • View reference on publisher's website
  12. De Jonghe B, Sharshar T, Lefaucheur J-P et al (2002) Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA 288:2859–2867
    • View reference on publisher's website
    • View reference on PubMed
  13. Guerra C, Linde-Zwirble WT, Wunsch H (2012) Risk factors for dementia after critical illness in elderly medicare beneficiaries. Crit Care 16:R233. https://doi.org/10.1186/cc11901
    • View reference on publisher's website
    • View reference on PubMed
  14. Stevens RD, Dowdy DW, Michaels RK et al (2007) Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med 33:1876–1891. https://doi.org/10.1007/s00134-007-0772-2
  15. Unroe M, Kahn JM, Carson SS et al (2010) One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med 153:167–175. https://doi.org/10.7326/0003-4819-153-3-201008030-00007
    • View reference on publisher's website
    • View reference on PubMed
  16. Myhren H, Ekeberg Ø, Stokland O (2010) Health-related quality of life and return to work after critical illness in general intensive care unit patients: a 1-year follow-up study. Crit Care Med 38:1554–1561. https://doi.org/10.1097/CCM.0b013e3181e2c8b1
    • View reference on publisher's website
    • View reference on PubMed
  17. Wehler M, Geise A, Hadzionerovic D et al (2003) Health-related quality of life of patients with multiple organ dysfunction: individual changes and comparison with normative population. Crit Care Med 31:1094–1101. https://doi.org/10.1097/01.CCM.0000059642.97686.8B
    • View reference on publisher's website
    • View reference on PubMed
  18. Kamdar BB, Huang M, Dinglas VD et al (2017) Joblessness and lost earnings after acute respiratory distress syndrome in a 1-year national multicenter study. Am J Respir Crit Care Med 196:1012–1020. https://doi.org/10.1164/rccm.201611-2327OC
    • View reference on publisher's website
    • View reference on PubMed
  19. Kamdar BB, Sepulveda KA, Chong A et al (2017) Return to work and lost earnings after acute respiratory distress syndrome: a 5-year prospective, longitudinal study of long-term survivors. Thorax. https://doi.org/10.1136/thoraxjnl-2017-210217
    • View reference on PubMed
  20. Norman BC, Jackson JC, Graves JA et al (2016) Employment outcomes after critical illness: an analysis of the bringing to light the risk factors and incidence of neuropsychological dysfunction in ICU survivors cohort. Crit Care Med 44:2003–2009. https://doi.org/10.1097/CCM.0000000000001849
    • View reference on publisher's website
    • View reference on PubMed
  21. Ringdal M, Plos K, Ortenwall P, Bergbom I (2010) Memories and health-related quality of life after intensive care: a follow-up study. Crit Care Med 38:38–44. https://doi.org/10.1097/CCM.0b013e3181b42909
    • View reference on publisher's website
    • View reference on PubMed
  22. Livingston DH, Tripp T, Biggs C, Lavery RF (2009) A fate worse than death? Long-term outcome of trauma patients admitted to the surgical intensive care unit. J Trauma 67:341–348. https://doi.org/10.1097/ta.0b013e3181a5cc34
    • View reference on publisher's website
    • View reference on PubMed
  23. Jackson JC, Obremskey W, Bauer R et al (2007) Long-term cognitive, emotional, and functional outcomes in trauma intensive care unit survivors without intracranial hemorrhage. J Trauma 62:80–88. https://doi.org/10.1097/TA.0b013e31802ce9bd
    • View reference on publisher's website
    • View reference on PubMed
  24. Eddleston JM, White P, Guthrie E (2000) Survival, morbidity, and quality of life after discharge from intensive care. Crit Care Med 28:2293–2299
    • View reference on publisher's website
    • View reference on PubMed
  25. Turnbull AE, Rabiee A, Davis WE et al (2016) Outcome measurement in ICU survivorship research from 1970 to 2013: a scoping review of 425 publications. Crit Care Med 44:1267–1277. https://doi.org/10.1097/CCM.0000000000001651
    • View reference on publisher's website
    • View reference on PubMed
  26. Schmidt M, Schmidt SAJ, Sandegaard JL et al (2015) The Danish national patient registry: a review of content, data quality, and research potential. Clin Epidemiol 7:449–490. https://doi.org/10.2147/CLEP.S91125
    • View reference on publisher's website
    • View reference on PubMed
  27. Kragholm K, Wissenberg M, Mortensen RN et al (2015) Return to work in out-of-hospital cardiac arrest survivors: a nationwide register-based follow-up study. Circulation 131:1682–1690. https://doi.org/10.1161/CIRCULATIONAHA.114.011366
    • View reference on publisher's website
    • View reference on PubMed
  28. Schmidt M, Pedersen L, Sørensen HT (2014) The Danish civil registration system as a tool in epidemiology. Eur J Epidemiol 29:541–549. https://doi.org/10.1007/s10654-014-9930-3
    • View reference on publisher's website
    • View reference on PubMed
  29. Christiansen CF, Møller MH, Nielsen H, Christensen S (2016) The Danish intensive care database. Clin Epidemiol 8:525–530. https://doi.org/10.2147/CLEP.S99476
    • View reference on publisher's website
    • View reference on PubMed
  30. Hjollund NH, Larsen FB, Andersen JH (2007) Register-based follow-up of social benefits and other transfer payments: accuracy and degree of completeness in a Danish interdepartmental administrative database compared with a population-based survey. Scand J Public Health 35:497–502. https://doi.org/10.1080/14034940701271882
    • View reference on publisher's website
    • View reference on PubMed
  31. Schmidt M, Schmidt SAJ, Sandegaard JL et al (2015) The Danish national patient registry: a review of content, data quality, and research potential. Clin Epidemiol 7:449–490. https://doi.org/10.2147/CLEP.S91125
    • View reference on publisher's website
    • View reference on PubMed
  32. Kildemoes HW, Sørensen HT, Hallas J (2011) The Danish national prescription registry. Scand J Public Health 39:38–41. https://doi.org/10.1177/1403494810394717
    • View reference on publisher's website
    • View reference on PubMed
  33. Christensen S, Johansen MB, Christiansen CF et al (2011) Comparison of Charlson comorbidity index with SAPS and APACHE scores for prediction of mortality following intensive care. Clin Epidemiol 3:203–211. https://doi.org/10.2147/CLEP.S20247
    • View reference on publisher's website
    • View reference on PubMed
  34. Thygesen SK, Christiansen CF, Christensen S et al (2011) The predictive value of ICD-10 diagnostic coding used to assess Charlson comorbidity index conditions in the population-based Danish National Registry of Patients. BMC Med Res Methodol 11:83. https://doi.org/10.1186/1471-2288-11-83
    • View reference on publisher's website
    • View reference on PubMed
  35. Shrier I, Platt RW (2008) Reducing bias through directed acyclic graphs. BMC Med Res Methodol 8:70. https://doi.org/10.1186/1471-2288-8-70
    • View reference on publisher's website
    • View reference on PubMed
  36. Bartlett JW, Seaman SR, White IR et al (2015) Multiple imputation of covariates by fully conditional specification: accommodating the substantive model. Stat Methods Med Res 24:462–487. https://doi.org/10.1177/0962280214521348
    • View reference on publisher's website
    • View reference on PubMed
  37. R Core Team (2008) R: a language and environment for statistical computing. R Project for Statistical Computing, Vienna. https://www.r-project.org/
  38. Oeyen S, Vandijck D, Benoit D et al (2007) Long-term outcome after acute kidney injury in critically-ill patients. Acta Clin Belg 62(Suppl 2):337–340
    • View reference on publisher's website
    • View reference on PubMed
  39. Norman BC, Jackson JC, Graves JA et al (2016) Employment outcomes after critical illness. Crit Care Med 44:2003–2009. https://doi.org/10.1097/CCM.0000000000001849
    • View reference on publisher's website
    • View reference on PubMed
  40. Blichert-Hansen L, Nielsson MS, Nielsen RB et al (2013) Validity of the coding for intensive care admission, mechanical ventilation, and acute dialysis in the Danish National Patient Registry: a short report. Clin Epidemiol 5:9–12. https://doi.org/10.2147/CLEP.S37763
    • View reference on PubMed
  41. Hjollund NH, Larsen FB, Andersen JH (2007) Register-based follow-up of social benefits and other transfer payments: accuracy and degree of completeness in a Danish interdepartmental administrative database compared with a population-based survey. Scand J Public Health 35:497–502. https://doi.org/10.1080/14034940701271882
    • View reference on publisher's website
    • View reference on PubMed

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