Prolonged Stay in Intensive Care Unit Is a Powerful Predictor of Adverse Outcomes After Cardiac Operations

• Published in: The Annals of thoracic surgery Vol. 94; no. 1; pp. 109 - 116
• Main Authors: Mahesh, Balakrishnan, FRCS, PhD, Choong, Cliff K., MD, FRCS, Goldsmith, Kimberley, MD, Gerrard, Caroline, RN, Nashef, Samer A.M., FRCS, PhD, Vuylsteke, Alain, MD, FRCA
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-07-2012; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - mortality; Cardiology. Vascular system; Cardiopulmonary Bypass; Cardiothoracic Surgery; Female; Humans; Intensive Care Units; Length of Stay; Male; Medical sciences; Middle Aged; Obesity - complications; Pneumology; Pulmonary Disease, Chronic Obstructive - complications; Retrospective Studies; Surgery; adult respiratory distress syndrome; C; IABP; European System for Cardiac Operative Risk Evaluation; myocardial infarction; LVEF; I; interquartile range; odds ratio; left ventricular ejection fraction; red blood cell; FFP; fresh frozen plasma; ICU stay of 3 days or longer (group I); SD; RBC; cardiopulmonary bypass; intensive care unit; MI; ARDS; BMI; coronary artery bypass grafting; OR; body mass index; 18; IQR; LOS; CPB; EuroSCORE; length of stay; ICU; controls (group C); CABG; intraaortic balloon pumping; COPD; chronic obstructive pulmonary disease; standard deviation; Heart; Prognosis; Treatment; Predictor; Surgery; Anesthesia; Circulatory system; Operation; Cardiology; Predictive factor; Intensive care unit; Prolonged
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.02.010

Background The aim of this study was to examine the impact of prolonged intensive care unit (ICU) stay on in-hospital mortality and long-term survival. Methods Prospectively collected data from 6,101 consecutive patients who underwent surgery between 2003 and 2007 were analyzed. Prolonged ICU stay was defined as a total duration of ICU stay of 3 days or more postoperatively, including readmissions; patients with an ICU stay less than 3 days were identified as controls. Univariate and multiple variable analyses were performed to identify risk factors associated with prolonged ICU stay. Results Of 6,101 patients, 1,139 (18.7%) patients had a prolonged ICU stay. These patients had a higher ICU mortality (10%) compared with controls (0.6%; p < 0.001). On discharge from the ICU, their hospital mortality was still 6-fold higher (1.2%) compared with controls (0.2%; p < 0.001). Finally, the patients who had prolonged ICU stays had lower survival after discharge from the ICU—89.2% and 81.2% at 1 year and 3 years, respectively, compared with 97.8% and 93.6%, respectively, for controls ( p < 0.001). Multiple variable analysis revealed prolonged ICU stay to be an independent predictor of prolonged hospital stay, higher hospital mortality, and poorer long-term survival (all p < 0.001). Conclusions Prolonged ICU stay is an important predictor of adverse immediate, short-term, and long-term outcomes after cardiac operations.