Prolonged Intensive Care Unit Stay of Patients after Cardiac Surgery: Initial Clinical Results and Follow-Up

Abstract

Background Prolonged intensive care unit (ICU) stay in cardiac surgery patients often results in a poorer clinical course and decreased survival postdischarge. Data on clinical outcomes and prognosis are limited. We aimed to identify perioperative factors that would predict prolonged ICU stay and to evaluate their impact on clinical outcomes.

Patients and Methods Demographic and clinical data on the perioperative course and outcome of 7,646 consecutive patients who underwent cardiac surgery at our institution were retrospectively analyzed over a 4-year period. Duration of ICU stay was defined as: less than 3 days (Group 1, n = 6,574), greater than 3 days (Group 2, n = 466), and more than 7 days (Group 3, n = 606).

Results The in-hospital mortality rate was significantly elevated in patients with a prolonged ICU stay (Group III, 16.1%; Group II, 8.4%; and Group I, 2.5%; p < 0.05). Prolonged ICU stay was associated with a complicated clinical course and a significantly higher incidence of respiratory and renal insufficiency. Multivariate analysis confirmed neurological, renal, and respiratory complications to be the predictive of prolonged ICU stay. Two-year survival also correlated with duration of ICU stay (Group I, 85.9%; Group II, 64.2%; and Group III, 57.4%; p < 0.0001).

Conclusion Prolonged ICU stay is associated with a complicated clinical course and decreased overall survival. Treatment for patients with respiratory impairment should be aggressively optimized.

Keywords

intensive care - mortality - morbidity - cardiac - heart valve surgery - aorta/aortic

• References

• 1 Gummert JF, Funkat AK, Beckmann A , et al. Cardiac surgery in Germany during 2010: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2011; 59 (5) 259-267
• 2 Bapat V, Allen D, Young C, Roxburgh J, Ibrahim M. Survival and quality of life after cardiac surgery complicated by prolonged intensive care. J Card Surg 2005; 20 (3) 212-217
• 3 Bashour CA, Yared JP, Ryan TA , et al. Long-term survival and functional capacity in cardiac surgery patients after prolonged intensive care. Crit Care Med 2000; 28 (12) 3847-3853
• 4 Gaudino M, Girola F, Piscitelli M , et al. Long-term survival and quality of life of patients with prolonged postoperative intensive care unit stay: unmasking an apparent success. J Thorac Cardiovasc Surg 2007; 134 (2) 465-469
• 5 Mazzoni M, De Maria R, Bortone F , et al. Long-term outcome of survivors of prolonged intensive care treatment after cardiac surgery. Ann Thorac Surg 2006; 82 (6) 2080-2087
• 6 Williams MR, Wellner RB, Hartnett EA , et al. Long-term survival and quality of life in cardiac surgical patients with prolonged intensive care unit length of stay. Ann Thorac Surg 2002; 73 (5) 1472-1478
• 7 Gersbach P, Tevaearai H, Revelly JP, Bize P, Chioléro R, von Segesser LK. Are there accurate predictors of long-term vital and functional outcomes in cardiac surgical patients requiring prolonged intensive care?. Eur J Cardiothorac Surg 2006; 29 (4) 466-472
• 8 Isgro F, Skuras JA, Kiessling AH, Lehmann A, Saggau W. Survival and quality of life after a long-term intensive care stay. Thorac Cardiovasc Surg 2002; 50 (2) 95-99
• 9 Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999; 16 (1) 9-13
• 10 Lagercrantz E, Lindblom D, Sartipy U. Survival and quality of life in cardiac surgery patients with prolonged intensive care. Ann Thorac Surg 2010; 89 (2) 490-495
• 11 Hein OV, Birnbaum J, Wernecke K, England M, Konertz W, Spies C. Prolonged intensive care unit stay in cardiac surgery: risk factors and long-term-survival. Ann Thorac Surg 2006; 81 (3) 880-885
• 12 Joskowiak D, Wilbring M, Szlapka M , et al. Readmission to the intensive care unit after cardiac surgery: a single-center experience with 7105 patients. J Cardiovasc Surg (Torino) 2012; 53 (5) 671-676
• 13 Ryan TA, Rady MY, Bashour CA, Leventhal M, Lytle B, Starr NJ. Predictors of outcome in cardiac surgical patients with prolonged intensive care stay. Chest 1997; 112 (4) 1035-1042
• 14 Turner JS, Morgan CJ, Thakrar B, Pepper JR. Difficulties in predicting outcome in cardiac surgery patients. Crit Care Med 1995; 23 (11) 1843-1850
• 15 Bucerius J, Gummert JF, Walther T , et al. Predictors of prolonged ICU stay after on-pump versus off-pump coronary artery bypass grafting. Intensive Care Med 2004; 30 (1) 88-95
• 16 Bacchetta MD, Ko W, Girardi LN , et al. Outcomes of cardiac surgery in nonagenarians: a 10-year experience. Ann Thorac Surg 2003; 75 (4) 1215-1220
• 17 Messaoudi N, De Cocker J, Stockman BA, Bossaert LL, Rodrigus IE. Is EuroSCORE useful in the prediction of extended intensive care unit stay after cardiac surgery?. Eur J Cardiothorac Surg 2009; 36 (1) 35-39
• 18 Williams MR, Wellner RB, Hartnett EA , et al. Long-term survival and quality of life in cardiac surgical patients with prolonged intensive care unit length of stay. Ann Thorac Surg 2002; 73 (5) 1472-1478
• 19 Hellgren L, Ståhle E. Quality of life after heart valve surgery with prolonged intensive care. Ann Thorac Surg 2005; 80 (5) 1693-1698
• 20 Yusuf S, Zucker D, Peduzzi P , et al. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet 1994; 344 (8922) 563-570 Erratum in: Lancet 1994 Nov 19;344(8934):1446
• 21 Roques F, Nashef SA, Michel P , et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 1999; 15 (6) 816-822 , discussion 822–823
• 22 Combes A, Costa MA, Trouillet JL , et al. Morbidity, mortality, and quality-of-life outcomes of patients requiring >or=14 days of mechanical ventilation. Crit Care Med 2003; 31 (5) 1373-1381