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Return to work after critical illness: a systematic review and meta-analysis
  1. Biren B Kamdar1,
  2. Rajat Suri2,
  3. Mary R Suchyta3,
  4. Kyle F Digrande4,
  5. Kyla D Sherwood5,
  6. Elizabeth Colantuoni6,7,
  7. Victor D Dinglas8,
  8. Dale M Needham6,8,
  9. Ramona O Hopkins9,10
  1. 1 Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, California, USA
  2. 2 Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  3. 3 InstaCare, Intermountain Health Care, Salt Lake City, Utah, USA
  4. 4 Department of Medicine, University of California Irvine, Irvine, California, USA
  5. 5 Department of Medicine, University of California San Francisco, San Francisco, California, USA
  6. 6 Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA
  7. 7 Department of Biostatistics, Johns Hopkins University—Bloomberg School of Public Health, Baltimore, Maryland, USA
  8. 8 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  9. 9 Center for Humanizing Critical Care, Intermountain Health Care, Murray, Utah, USA
  10. 10 Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah, USA
  1. Correspondence to Dr Biren B Kamdar, Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, La Jolla, CA 92037-7381, USA; kamdar{at}


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 (τ 2=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.

  • critical care
  • ARDS
  • clinical epidemiology

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  • Contributors Conception and design: BBK, MRS, DMN, RH. Analysis and interpretation: BBK, RS, MRS, KFD, KDS, EC, VDD, DMN, RH. Drafting the manuscript for important intellectual content: BBK, MRS, DMN, RH. Final approval of the version to be published: BBK, RS, MRS, KFD, KDS, EC, VDD, DMN, RH.

  • Funding BBK is supported by a Paul B Beeson Career Development Award through the National Institutes of Health/National Institute on Aging (K76AG059936). DMN is supported by funding from the National Institutes of Health/National Heart, Lung, and Blood Institute (R24HL111985). BBK had full access to the data and final responsibility for the decision to submit this study for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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