In-Hospital Mortality After Cardiac Surgery: Patient Characteristics, Timing, and Association With Postoperative Length of Intensive Care Unit and Hospital Stay

Abstract Background Statins may reduce the risk of pulmonary and neurologic complications after cardiac surgery. Methods The authors acquired data for adults who had coronary artery bypass graft, valve surgery, or combined procedures. The authors matched patients who took statins preoperatively to patients who did not. First, the authors assessed the association between preoperative statin use and the primary outcomes of prolonged ventilation (more than 24 h), pneumonia (positive cultures of sputum, transtracheal fluid, bronchial washings, and/or clinical findings consistent with the diagnosis of pneumonia), and in-hospital all-cause mortality, using logistic regressions. Second, the authors analyzed the collapsed composite of neurologic complications using logistic regression. Intensive care unit and hospital length of stay were evaluated with Cox proportional hazard models. Results Among 14,129 eligible patients, 6,642 patients were successfully matched. There was no significant association between preoperative statin use and prolonged ventilation (statin: 408/3,321 [12.3%] vs. nonstatin: 389/3,321 [11.7%]), pneumonia (44/3,321 [1.3%] vs. 54/3,321 [1.6%]), and in-hospital mortality (52/3,321 [1.6%] vs. 43/3,321 [1.3%]). The estimated odds ratio was 1.06 (98.3% CI, 0.88 to 1.27) for prolonged ventilation, 0.81 (0.50 to 1.32) for pneumonia, and 1.21 (0.74 to 1.99) for in-hospital mortality. Neurologic outcomes were not associated with preoperative statin use (53/3,321 [1.6%] vs. 56/3,321 [1.7%]), with an odds ratio of 0.95 (0.60 to 1.50). The length of intensive care unit and hospital stay was also not associated with preoperative statin use, with a hazard ratio of 1.04 (0.98 to 1.10) for length of hospital stay and 1.00 (0.94 to 1.06) for length of intensive care unit stay. Conclusions Preoperative statin use did not reduce pulmonary or neurologic complications after cardiac surgery.

Download Full-text

Objective Quantification of In-Hospital Patient Mobilization after Cardiac Surgery Using Accelerometers: Selection, Use, and Analysis

Sensors ◽

10.3390/s21061979 ◽

2021 ◽

Vol 21 (6) ◽

pp. 1979

Author(s):

Frank R. Halfwerk ◽

Jeroen H. L. van Haaren ◽

Randy Klaassen ◽

Robby W. van Delden ◽

Peter H. Veltink ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Hospital Stay ◽

Intensive Care Unit Stay ◽

Heart Surgery ◽

Mixed Model ◽

Postoperative Recovery ◽

Time In Bed ◽

Surgical Ward

Cardiac surgery patients infrequently mobilize during their hospital stay. It is unclear for patients why mobilization is important, and exact progress of mobilization activities is not available. The aim of this study was to select and evaluate accelerometers for objective qualification of in-hospital mobilization after cardiac surgery. Six static and dynamic patient activities were defined to measure patient mobilization during the postoperative hospital stay. Device requirements were formulated, and the available devices reviewed. A triaxial accelerometer (AX3, Axivity) was selected for a clinical pilot in a heart surgery ward and placed on both the upper arm and upper leg. An artificial neural network algorithm was applied to classify lying in bed, sitting in a chair, standing, walking, cycling on an exercise bike, and walking the stairs. The primary endpoint was the daily amount of each activity performed between 7 a.m. and 11 p.m. The secondary endpoints were length of intensive care unit stay and surgical ward stay. A subgroup analysis for male and female patients was planned. In total, 29 patients were classified after cardiac surgery with an intensive care unit stay of 1 (1 to 2) night and surgical ward stay of 5 (3 to 6) nights. Patients spent 41 (20 to 62) min less time in bed for each consecutive hospital day, as determined by a mixed-model analysis (p < 0.001). Standing, walking, and walking the stairs increased during the hospital stay. No differences between men (n = 22) and women (n = 7) were observed for all endpoints in this study. The approach presented in this study is applicable for measuring all six activities and for monitoring postoperative recovery of cardiac surgery patients. A next step is to provide feedback to patients and healthcare professionals, to speed up recovery.

Download Full-text

Esmolol before cardioplegia and as cardioplegia adjuvant reduces cardiac troponin release after cardiac surgery. A randomized trial

Perfusion ◽

10.1177/0267659116681437 ◽

2016 ◽

Vol 32 (4) ◽

pp. 313-320 ◽

Cited By ~ 9

Author(s):

Elena Bignami ◽

Marcello Guarnieri ◽

Annalisa Franco ◽

Chiara Gerli ◽

Monica De Luca ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Placebo Group ◽

Cardiopulmonary Bypass ◽

Hospital Stay ◽

Troponin T ◽

Mechanical Activity ◽

Double Blind ◽

Elective Cardiac Surgery

Background: Cardioplegic solutions are the standard in myocardial protection during cardiac surgery, since they interrupt the electro-mechanical activity of the heart and protect it from ischemia during aortic cross-clamping. Nevertheless, myocardial damage has a strong clinical impact. We tested the hypothesis that the short-acting beta-blocker esmolol, given immediately before cardiopulmonary bypass and as a cardioplegia additive, would provide an extra protection to myocardial tissue during cardiopulmonary bypass by virtually reducing myocardial activity and, therefore, oxygen consumption to zero. Materials and methods: This was a single-centre, double-blind, placebo-controlled, parallel-group phase IV trial. Adult patients undergoing elective valvular and non-valvular cardiac surgery with end diastolic diameter >60 mm and ejection fraction <50% were enrolled. Patients were randomly assigned to receive either esmolol, 1 mg/kg before aortic cross-clamping and 2 mg/kg with Custodiol® crystalloid cardioplegia or equivolume placebo. The primary end-point was peak postoperative troponin T concentration. Troponin was measured at Intensive Care Unit arrival and at 4, 24 and 48 hours. Secondary endpoints included ventricular fibrillation after cardioplegic arrest, need for inotropic support and intensive care unit and hospital stay. Results: We found a reduction in peak postoperative troponin T, from 1195 ng/l (690–2730) in the placebo group to 640 ng/l (544–1174) in the esmolol group (p=0.029) with no differences in Intensive Care Unit stay [3 days (1-6) in the placebo group and 3 days (2-5) in the esmolol group] and hospital stay [7 days (6–10) in the placebo group and 7 days (6–12) in the esmolol group]. Troponin peak occurred at 24 hours for 12 patients (26%) and at 4 hours for the others (74%). There were no differences in other secondary end-points. Conclusions: Adding esmolol to the cardioplegia in high-risk patients undergoing elective cardiac surgery reduces peak postoperative troponin levels. Further investigation is necessary to assess esmolol effects on major clinical outcomes.

Download Full-text

Intensive Care Unit Outcomes Among Patients With Lung Cancer in the Surveillance, Epidemiology, and End Results–Medicare Registry

Journal of Clinical Oncology ◽

10.1200/jco.2011.40.0846 ◽

2012 ◽

Vol 30 (14) ◽

pp. 1686-1691 ◽

Cited By ~ 54

Author(s):

Christopher G. Slatore ◽

Laura M. Cecere ◽

Jennifer L. LeTourneau ◽

Maya E. O'Neil ◽

Jonathan P. Duckart ◽

...

Keyword(s):

Lung Cancer ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Hospital Mortality ◽

Surgical Resection ◽

Cox Regression ◽

Patient Characteristics ◽

Patient Centered ◽

End Results

Purpose Lung cancer is the leading cause of cancer-related mortality. Intensive care unit (ICU) use among patients with cancer is increasing, but data regarding ICU outcomes for patients with lung cancer are limited. Patients and Methods We used the Surveillance, Epidemiology, and End Results (SEER) –Medicare registry (1992 to 2007) to conduct a retrospective cohort study of patients with lung cancer who were admitted to an ICU for reasons other than surgical resection of their tumor. We used logistic and Cox regression to evaluate associations of patient characteristics and hospital mortality and 6-month mortality, respectively. We calculated adjusted associations for mechanical ventilation receipt with hospital and 6-month mortality. Results Of the 49,373 patients with lung cancer admitted to an ICU for reasons other than surgical resection, 76% of patients survived the hospitalization, and 35% of patients were alive 6 months after discharge. Receipt of mechanical ventilation was associated with increased hospital mortality (adjusted odds ratio, 6.95; 95% CI, 6.89 to 7.01; P < .001), and only 15% of these patients were alive 6 months after discharge. Of all ICU patients with lung cancer, the percentage of patients who survived 6 months from discharge was 36% for patients diagnosed in 1992 and 32% for patients diagnosed in 2005, whereas it was 16% and 11% for patients who received mechanical ventilation, respectively. Conclusion Most patients with lung cancer enrolled in Medicare who are admitted to an ICU die within 6 months of admission. To improve patient-centered care, these results should guide shared decision making between patients with lung cancer and their clinicians before an ICU admission.

Download Full-text

Performance of Sequential Organ Failure Assessment and Simplified Acute Physiology Score II for Post-Cardiac Surgery Patients in Intensive Care Unit

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.774935 ◽

2021 ◽

Vol 8 ◽

Author(s):

Fei Xu ◽

Weina Li ◽

Cheng Zhang ◽

Rong Cao

Keyword(s):

Cardiac Surgery ◽

Intensive Care ◽

Hospital Mortality ◽

Hospital Stay ◽

Scoring System ◽

Simplified Acute Physiology Score ◽

Saps Ii ◽

Icu Stay ◽

Cutoff Values ◽

Adjusted Model

Background: The aim of this study is to assess the performance of Sequential Organ Failure Assessment (SOFA) score and Simplified Acute Physiology Score (SAPS II) on outcomes of patients with cardiac surgery and identify the cutoff values to provide a reference for early intervention.Methods: All data were extracted from MIMIC-III (Medical Information Mart for Intensive Care-III) database. Cutoff values were calculated by the receiver-operating characteristic curve and Youden indexes. Patients were grouped, respectively, according to the cutoff values of SOFA and SAPS II. A non-adjusted model and adjusted model were established to evaluate the prediction of risk. Comparison of clinical efficacy between two scoring systems was made by decision curve analysis (DCA). The primary outcomes of this study were in-hospital mortality, 28-day mortality, 90-day mortality, and 1-year mortality after cardiac surgery. The secondary outcomes included length of hospital stay and intensive care unit (ICU) stay and the incidence of acute kidney injury (AKI) within 7 days after ICU admission.Results: A total of 6,122 patients were collected and divided into the H-SOFA group (SOFA ≥ 7) and L-SOFA group (SOFA < 7) or H-SAPS II group (SAPS II ≥ 43) and L-SAPS II group (SAPS II < 43). In-hospital mortality, 28-day mortality, 90-day mortality, and 1-year mortality were higher, the length of hospital and ICU stay were longer in the H-SOFA group than in the L-SOFA group (p < 0.05), while the incidence of AKI was not significantly different. In-hospital mortality, 28-day mortality, 90-day mortality, 1-year mortality, and the incidence of AKI were all significantly higher in the H-SAPS II group than in the L-SAPS II group (p < 0.05). Hospital stay and ICU stay were longer in the H-SAPS II group than in the L-SAPS II group (p < 0.05). According to DCA, the SAPS II scoring system had more net benefits on assessing the long-term mortality compared with the SOFA scoring system.Conclusion: Exceeding the cutoff values of SOFA and SAPS II scores could lead to increased mortality and extended length of ICU and hospital stay. The SAPS II scoring system had a better discriminative performance of 90-day mortality and 1-year mortality in post-cardiac surgery patients than the SOFA scoring system. Emphasizing the critical value of the scoring system is of significance for timely treatment.

Download Full-text

Effect of Cardiac Surgery Patient Characteristics on Patient Outcomes From 1981 Through 1995

Circulation ◽

10.1161/01.cir.96.5.1575 ◽

1997 ◽

Vol 96 (5) ◽

pp. 1575-1579 ◽

Cited By ~ 45

Author(s):

Christi D. Warner ◽

William S. Weintraub ◽

Joseph M. Craver ◽

Ellis L. Jones ◽

John Parker Gott ◽

...

Keyword(s):

Cardiac Surgery ◽

Patient Outcomes ◽

Patient Characteristics ◽

Cardiac Surgery Patient ◽

Surgery Patient

Download Full-text

Risk Factors and Outcomes Associated With Readmission to the Intensive Care Unit After Cardiac Surgery

AACN Advanced Critical Care ◽

10.4037/aacnacc2016451 ◽

2016 ◽

Vol 27 (1) ◽

pp. 29-39 ◽

Cited By ~ 3

Author(s):

Young Ae Kang

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cardiac Surgery ◽

Intensive Care ◽

Hospital Stay ◽

Operation Time ◽

Unplanned Readmission ◽

High Blood Glucose ◽

Icu Discharge

Unplanned readmission to the intensive care unit (ICU) is associated with poor prognosis, longer hospital stay, increased costs, and higher mortality rate. In this retrospective study, involving 1368 patients, the risk factors for and outcomes of ICU readmission after cardiac surgery were analyzed. The readmission rate was 5.9%, and the most common reason for readmission was cardiac issues. Preoperative risk factors were comorbid conditions, mechanical ventilation, and admission route. Perioperative risk factors were nonelective surgery, duration of cardiopulmonary bypass, and longer operation time. Postoperative risk factors were prolonged mechanical ventilation time, new-onset arrhythmia, unplanned reoperation, massive blood transfusion, prolonged inotropic infusions, and complications. Other factors were high blood glucose level, hemoglobin level, and score on the Acute Physiology and Chronic Health Evaluation II. In-hospital stay was longer and late mortality was higher in the readmitted group. These data could help clinical practitioners create improved ICU discharge protocols or treatment algorithms to reduce length of stay or to reduce readmissions.

Download Full-text

Risk Factors for Adverse Postoperative Outcomes in Children Presenting for Cardiac Surgery with Upper Respiratory Tract Infections

Anesthesiology ◽

10.1097/00000542-200303000-00009 ◽

2003 ◽

Vol 98 (3) ◽

pp. 628-632 ◽

Cited By ~ 48

Author(s):

Shobha Malviya ◽

Terri Voepel-Lewis ◽

Monica Siewert ◽

Uma A. Pandit ◽

Lori Q. Riegger ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Postoperative Complications ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Healthy Children ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Tract Infections

Background Otherwise healthy children who present for elective surgery with an upper respiratory infection (URI) may be at risk for perioperative respiratory complications. This risk may be increased in children with congenital heart disease who undergo cardiac surgery while harboring a URI because of their compromised cardiopulmonary status. Therefore, this study was designed to determine the incidence of peri- and postoperative complications in children undergoing cardiac surgery while harboring a URI. Methods The study population consisted of 713 children scheduled to undergo cardiac surgery. Of these, 96 had symptoms of URI, and 617 were asymptomatic. Children were followed prospectively from induction of anesthesia to discharge from the hospital to determine the incidence of postoperative respiratory, cardiovascular, neurologic, and surgical adverse events. Duration of postoperative ventilation, time in the intensive care unit (ICU), and length of hospital stay were also recorded. Results Children with URIs had a significantly higher incidence of respiratory and multiple postoperative complications than children with no URIs (29.2 vs 17.3% and 25 vs 10.3%, respectively; P< 0.01) and a higher incidence of postoperative bacterial infections (5.2 vs 1.0%; P= 0.01). Furthermore, logistic regression indicated that the presence of a URI was an independent risk factor for multiple postoperative complications and postoperative infections in children undergoing open heart surgery. Children with URIs also stayed longer in the intensive care unit than children with no URIs (75.9 +/- 89.8 h vs 57.7 +/- 63.8, respectively; P< 0.01). However, the overall length of hospital stay was not significantly different (8.4 vs 7.8 days, URI vs non-URI groups; P> 0.05). Conclusions The presence of a URI was predictive of postoperative infection and multiple complications in children presenting for cardiac surgery. Despite this, the presence of a URI does not appear to affect the patient's overall length of hospital stay nor the development of long-term sequelae.

Download Full-text