LAUSR

There are multiple metrics that assess various components of health-related quality of life (HRQoL). A recent article that appeared in the Journal describes a preliminary study to use multiple metrics to assess various components of HRQoL. The authors used multiple published studies to obtain an expansive list of responses that address many components of HRQoL. Their work represents a preliminary attempt at defining intermediate term (3 months to one year) HRQoL in patients who had a moderately prolonged ICU stay (equal to or greater than 5 days). In this cohort the authors found that there were persistent difficulties with activities of daily living and need for more family and external support. The authors view their study as a preliminary approach that advocates for closer long-term follow up of patients with prolonged ICU stay. There were limitations to the authors' analysis that stem from their small sample size and from the abundance of potential metrics that could be used to define problems with long-term HRQoL after complex cardiac operations. Further, there are some methodologic concerns in the authors' data analysis that revolve around their choice of an independent variable - ICU length-of-stay. Because of data limitations the authors converted a continuous variable (ICU days) into a discrete variable (< 5 ICU days versus ≥ 5 ICU days) with concomitant reduced statistical power and probable underestimation of certain outcome differences. The authors hope and expect that their preliminary efforts will challenge and encourage further understanding of HRQoL in patients after complicated cardiac operations.