Return to work after critical illness: a systematic review and meta-analysis

Abstract

Background: Survivors of critical illness often experience poor outcomes after hospitalisation, including delayed return to work, which carries substantial economic consequences.

Objective: To conduct a systematic review and meta-analysis of return to work after critical illness.

Methods: We searched PubMed, Embase, PsycINFO, CINAHL and Cochrane Library from 1970 to February 2018. Data were extracted, in duplicate, and random-effects meta-regression used to obtain pooled estimates.

Results: Fifty-two studies evaluated return to work in 10 015 previously employed survivors of critical illness, over a median (IQR) follow-up of 12 (6.25-38.5) months. By 1-3, 12 and 42-60 months' follow-up, pooled return to work prevalence (95% CI) was 36% (23% to 49%), 60% (50% to 69%) and 68% (51% to 85%), respectively (τ²=0.55, I²=87%, p=0.03). No significant difference was observed based on diagnosis (acute respiratory distress syndrome (ARDS) vs non-ARDS) or region (Europe vs North America vs Australia/New Zealand), but was observed when comparing mode of employment evaluation (in-person vs telephone vs mail). Following return to work, 20%-36% of survivors experienced job loss, 17%-66% occupation change and 5%-84% worsening employment status (eg, fewer work hours). Potential risk factors for delayed return to work include pre-existing comorbidities and post-hospital impairments (eg, mental health).

Conclusion: Approximately two-thirds, two-fifths and one-third of previously employed intensive care unit survivors are jobless up to 3, 12 and 60 months following hospital discharge. Survivors returning to work often experience job loss, occupation change or worse employment status. Interventions should be designed and evaluated to reduce the burden of this common and important problem for survivors of critical illness.

Trial registration number: PROSPERO CRD42018093135.

Keywords: ARDS; clinical epidemiology; critical care.

Figure 1.. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram

Figure 2.

Proportion of survivors returning to work after critical illness, among 38 studies with discrete follow-up time points. Black squares represent pooled proportions (with 95% confidence intervals) by that time point: 36% (23–49%) by 1 to 3 months, 64% (52–75%) by 6 months, 60% (50–69%) by 12 months, 63% (44–82%) by 18 to 36 months, and 68% (51–85%) by 42 to 60 months. Pooled estimates calculated using random effects meta-regression. For the 3 pairs of estimates falling within the same follow-up stratum, only the final follow-up point estimate was included. Bubbles represent 53 point estimates from the 38 studies, with bubble size corresponding to study sample size.