Return to work after discharge from the intensive care unit: a Brazilian multicenter cohort

ABSTRACT Objective: To describe the rate and factors related to nonreturn to work in the third month after discharge from the intensive care unit and the impact of unemployment, loss of income and health care expenses for survivors. Methods: This was a prospective multicenter cohort study that included survivors of severe acute illness who were hospitalized between 2015 and 2018, previously employed, and who stayed more than 72 hours in the intensive care unit. Outcomes were assessed by telephone interview in the third month after discharge. Results: Of the 316 patients included in the study who had previously worked, 193 (61.1%) did not return to work within 3 months after discharge from the intensive care unit. The following factors were associated with nonreturn to work: low educational level (prevalence ratio 1.39; 95%CI 1.10 - 1.74; p = 0.006), previous employment relationship (prevalence ratio 1.32; 95%CI 1 10 - 1.58; p = 0.003), need for mechanical ventilation (prevalence ratio 1.20; 95%CI 1.01 - 1.42; p = 0.04) and physical dependence in the third month after discharge (prevalence ratio 1.27; 95%CI 1.08 - 1.48; p = 0.003). Survivors who were unable to return to work more often had reduced family income (49.7% versus 33.3%; p = 0.008) and increased health expenditures (66.9% versus 48.3%; p = 0.002). compared to those who returned to work in the third month after discharge from the intensive care unit. Conclusion: Intensive care unit survivors often do not return to work until the third month after discharge from the intensive care unit. Low educational level, formal job, need for ventilatory support and physical dependence in the third month after discharge were related to nonreturn to work. Failure to return to work was also associated with reduced family income and increased health care costs after discharge.摘要 目的：描述重症监护病房（Intensive Care Unit，ICU）出院后3个月内未重返工作岗位的发生率及相关影响因素，同时分析失业、收入损失与医疗开支对幸存者的影响。方法：本研究为前瞻性多中心队列研究，纳入2015至2018年间住院的重症急性疾病幸存者，所有受试者既往均有职业且在ICU停留时长超过72小时。研究结局于出院后3个月通过电话访谈进行评估。结果：纳入研究的316名既往在职患者中，193例（61.1%）在ICU出院后3个月内未重返工作岗位。与未重返工作岗位相关的危险因素包括：低学历（患病率比1.39；95%置信区间1.10~1.74；P=0.006）、既往正式雇佣关系（患病率比1.32；95%置信区间1.10~1.58；P=0.003）、需机械通气（mechanical ventilation）支持（患病率比1.20；95%置信区间1.01~1.42；P=0.04）以及出院后3个月存在躯体功能依赖（患病率比1.27；95%置信区间1.08~1.48；P=0.003）。相较于ICU出院后3个月内重返工作岗位的幸存者，无法重返工作岗位的幸存者更常出现家庭收入减少（49.7% vs 33.3%；P=0.008）及医疗支出增加（66.9% vs 48.3%；P=0.002）。结论：ICU幸存者在出院后3个月内常无法重返工作岗位。低学历、正式就业、需呼吸支持以及出院后3个月的躯体功能依赖均与未重返工作岗位相关。未能重返工作岗位还与出院后家庭收入减少及医疗成本增加有关。