Impact of somatic severity on long-term mortality in anorexia nervosa.

PURPOSE: Anorexia nervosa (AN) is a severe pathology on account of the high levels of associated morbidity and mortality. This study aimed to assess whether time in somatic intensive care unit, justified by a patient's somatic condition in the course of hospital care, has any relationship with patient outcome in terms of mortality in the long term. METHODS: 195 patients were hospitalised for AN between April 1996 and May 2002, 97 were re-assessed 9 years later on average. RESULTS: Out of 195 patients hospitalised for AN between April 1996 and May 2002, 29 had required transfer to intensive care. Mortality at 9 years was 20 times higher in the group having been transferred to intensive care, irrespective of the duration of follow-up. CONCLUSION: The clinical seriousness of the somatic condition during hospitalisation for AN is a risk factor for excess mortality in the medium term.

Quality of life after complicated elective surgery requiring intensive care.

OBJECTIVE: To evaluate outcomes of patients admitted to the ICU for complications after elective surgery and to assess perceived quality of life (pQOL) in survivors. DESIGN: Two-year prospective case-control study. SETTING: Twelve-bed ICU in a university-affiliated hospital. PATIENTS: Patients admitted to the ICU for a complication following elective surgery were included. Six months after discharge, pQOL was assessed using the Nottingham Health Profile (NHP). Results were compared to those of matched controls without complications. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Of the 182 patients, 124 were alive after 6 months, among whom 116 had 6-month data and 104 of these had matched controls. Overall pQOL as assessed by the global NHP score was similar in both groups (median, 0.82 and 0.87 in cases and controls; P=0.24). NHP subscores showed significantly worse pain ( P=0.03) and physical impairment ( P=0.02) in the ICU patients. In the multivariate analysis, pQOL was better in patients with cancer as the reason for surgery ( P=0.05). Severity of illness at inclusion had no influence on subsequent pQOL, but cardiovascular dysfunction was associated with decreased energy ( P=0.04). CONCLUSIONS: Although overall pQOL was satisfactory after 6 months, patients admitted to the ICU for postoperative complications had worse pain and physical impairment than controls. Whether these outcomes could be improved by early physiotherapy and aggressive pain management deserves investigation.