Organ support therapy in the intensive care unit and return to work: a nationwide, register-based cohort study
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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.
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.
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.
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.
KeywordsOrgan support therapy Return to work Disability Income Long-term outcome
We thank the Danish ICUs for reporting data on organ support treatments, ICU admission and SAPS II scores to the Danish National Registry of Patients according to the definitions made by the Danish Intensive Care Database.
This study was supported by Grant 271-05-0511 from the Danish Medical Research Council, the Clinical Institute at Aarhus University and the Department of Clinical Epidemiology’s Research Foundation at Aarhus University Hospital.
Compliance with ethical standards
Conflicts of interest
The corresponding author has no conflicts of interests to disclosure. Dr. Kragholm has received research grants from the Danish Heart Foundation, the Laerdal Foundation and the Fund of Herta Christensen, Denmark, and has received speaker’s honoraria from Novartis. Dr. Rasmussen has received research grants from Innovation Fund Denmark. None of these institutions or companies had any influence on the conduct or design of the study; the collection, management, analysis and interpretation of the data; or the preparation, review or approval of the manuscript for submission. All other authors have no conflicts of interests to disclose.
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