Original article
Cardiovascular
Prolonged Intensive Care Unit Stay in Cardiac Surgery: Risk Factors and Long-Term-Survival

https://doi.org/10.1016/j.athoracsur.2005.09.077Get rights and content

Background

Risk factors have been found for prolonged intensive care unit (ICU) stay in cardiac surgery patients in only a few studies; conflicting results have been described. The focus of this study was twofold: first, to evaluate preoperative, intraoperative, and postoperative risk factors for ICU stay greater than 3 days in a cardiac surgery patient population; second, to evaluate long-term survival in cardiac surgery patients with prolonged ICU stay.

Methods

Records from 2,683 cardiac surgery patients were retrospectively evaluated. Univariate and multivariate analyses for risk factors were performed for an ICU stay greater than 3 days. Thereafter, 2,563 patients were enrolled in a follow-up study for an observational time of 3 years after surgery.

Results

Mortality was dependent on renal, respiratory, and heart failure, as well as age, elevated APACHE II scores, and reexploration. Long-term survival analyses demonstrated a significantly lower survival in patients with longer ICU stay. However, the 6-month to 3-year long-term survival was comparable with survival in patients without prolonged ICU stay.

Conclusions

Because of the increasing acuity of patients needing cardiac surgery, it is important to identify those at risk for a prolonged ICU course. It is therefore of paramount interest to implement measures throughout their entire hospital stay that would maximize organ function to improve survival and resource utilization.

Section snippets

Patients and Methods

This study was approved by the ethical committee of the hospital Charité-University Medicine Berlin, Germany, on July 2004. Individual consent was waived.

Results

Baseline and outcome measurements are presented in Table 1. Other demographic variables analyzed, as well as preoperative, intraoperative, and postoperative risk factors, are described in Table 2.

Comment

Our study showed a significantly increased ICU, hospital, and long-term mortality in the patients with an ICU stay greater than 3 days in comparison with the patients with an ICU stay 3 days or less. However, the 6-month to 3-year long-term survival was comparable to survival in the patients without prolonged ICU stay.

Independent risk factors for an ICU stay greater than 3 days were related to perioperative risk factors such as age, catecholamine therapy, IABP, ARF-D, respiratory failure, and

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