Employment Outcomes After Critical Illness: An Analysis of the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors Cohort

Abstract

Objectives: To characterize survivors' employment status after critical illness and to determine if duration of delirium during hospitalization and residual cognitive function are each independently associated with decreased employment.

Design: Prospective cohort investigation with baseline and in-hospital clinical data and follow-up at 3 and 12 months.

Setting: Medical and surgical ICUs at two tertiary-care hospitals.

Patients: Previously employed patients from the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors study who survived a critical illness due to respiratory failure or shock were evaluated for global cognition and employment status at 3- and 12-month follow-up.

Measurements and main results: We used multivariable logistic regression to evaluate independent associations between employment at both 3 and 12 months and global cognitive function at the same time point, and delirium during the hospital stay. At 3-month follow-up, 113 of the total survival cohort of 448 (25%) were identified as being employed at study enrollment. Of these, 94 survived to 12-month follow-up. At 3- and 12-month follow-up, 62% and 49% had a decrease in employment, 57% and 49% of whom, respectively, were newly unemployed. After adjustment for physical health status, depressive symptoms, marital status, level of education, and severity of illness, we did not find significant predictors of employment status at 3 months, but better cognition at 12 months was marginally associated with lower odds of employment reduction at 12 months (odds ratio, 0.49; p = 0.07).

Conclusions: Reduction in employment after critical illness was present in the majority of our ICU survivors, approximately half of which was new unemployment. Cognitive function at 12 months was a predictor of subsequent employment status. Further research is needed into the potential relationship between the impact of critical illness on cognitive function and employment status.

Figure 1

Consort diagram illustrating the formation of the BRAIN-ICU Employment Cohort.

Figure 2. Level of Employment over Time amongst Survivors

Histogram demonstrating the number of patients employed at each level pre-enrollment, at 3-month follow-up, and at 12-month follow-up. Blue bars represent number of patients employed full time, green represents part time, red represents unemployed, and purple is those lost to follow-up. Almost all employed patients were employed full time prior to critical illness. The majority of employment change at 3-months was to unemployed (N=64, 57%). Some patients regained part-time employment by 12-months; however a significant proportion remained totally unemployed (n=45, 47%). Changes in numbers over time indicate deaths or lost to follow-up among the cohort.