Survival, Hospitalization Charges and Follow-up Results in Critically Ill Patients

In 226 consecutive critically ill primarily postoperative patients, we determined survival and quality of life, hospitalizaron charges, and consumption of blood and blood products. The patients were physiologically unstable and required intensive physician and nursing care. By one month, 123 patients had died (54 per cent), 70 were still hospitalized, and 31 were home; only one of 103 survivors had fully recovered. By 12 months, 164 patients (73 per cent) had died, 10 were still hospitalized, and 51 were home. Twenty-seven of 62 survivors had fully recovered. Hospitalization charges averaged $14,304 per patient. The total charge for blood and blood fractions was $617,710 — 21 per cent of the total hospitalization charge; $515,711 (83 per cent) of the blood charge went to 164 nonsurvivors, whereas $101,939 (17 per cent) went to the 62 survivors. These data document the use of increasingly limited resources in the management of critically ill patients. The medical profession must make difficult decisions to allocate these resources effectively. (N Engl J Med 294:982-987, 1976). The critically ill patient needs and receives enormous resources to maintain viability and progress towards a successful recovery. Personnel, time, physical and emotional effort, vast sums of money, space, highly sophisticated equipment, blood and blood products are all used to provide optimal care. However, very few data exist concerning the outcome of intensive care for the critically ill patient. Hence, resources are expended without knowledge of who does and does not benefit from intensive-care medicine. Physicians responsible for ordering health care expect unlimited resources to be marshaled for the critically ill patient, and yet remain unaware of the results of.