10 CHAPTER 1 SHIFTING FOCUS Since the number of patients surviving an admission to the ICU has increased over the last decade, a shift in focus is needed to grasp the full sequalae of this major life event.17 Each year, between 60.000 and 80.000 people are admitted to the ICU in the Netherlands.18 Of these patients, around a third are admitted per protocol following a planned surgical intervention. It is commonly known that unplanned ICU-admissions are associated with longer ICU length of stay (LOS) and a higher severity of illness, reflecting in an increased risk for long- term impaired health. However, in this patient group in particular, commonly used markers for recovery, often referred to as lack of mortality or readmission to the hospital, may not suffice in predicting meaningful recovery in the post-acute phase. Although ICU-discharge usually means the patient is no longer in an acute, life-threatening situation, this is only just the starting point for the complex road to recovery. Looking beyond mortality and considering the multifactorial nature of meaningful recovery is essential to acquire in-depth information regarding the long-term impact of critical illness (Box 1 & Figure 1). Figure 1. A selection of important pre, during, and post-ICU factors impacting the ability to reach meaningful recovery. Meaningful recovery Preadmission frailty Comorbidities Nutritional status Socioeconomic context ICU & hospital characteristics ICU treatment Delirium Physiological changes Rehabilitation potential Persistent disease factors Available aftercare Social support
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