Infectious Complications and Cost-Effectiveness of Open Resuscitation in the Surgical Intensive Care Unit after Cardiac Surgery

1985 ◽  
Vol 40 (4) ◽  
pp. 388-392 ◽  
Author(s):  
Robert L. McKowen ◽  
George J. Magovern ◽  
George A. Liebler ◽  
Sang B. Park ◽  
John A. Burkholder ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cost Effectiveness ◽  
Infectious Complications ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care

Abstract 105: 24/7 In-House Consultant Staffing for Cardiac Surgical ICU Patients: A Cost-Effective Model

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Kanwal Kumar ◽  
Brett Hiebert ◽  
Hilary P Grocott ◽  
Dean D Bell ◽  
Ryan Zarychanski ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cost Effectiveness ◽  
Cohort Analysis ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Operative Care ◽  
Tertiary Center ◽  
The Cost

Introduction: Intensive care staffing models vary amongst institutions. There is increasing evidence that in-house consultant care is beneficial in the intensive care unit. We have previously published beneficial results associated with 24-hour / 7-days a week in-house consultants working in a dedicated post-cardiac surgical unit. The cost-effectiveness of employing 24-hour / 7-days a week in-house consultants (both in the postoperative cardiac surgery and the general systems intensive care unit settings) remains largely unknown. The objective of this study was to analyze the cost implications of such a model. Methods: Using a prospectively collected database, an observational before and after cohort analysis of consecutive patients undergoing a cardiac surgical procedure at a single tertiary center was performed. The control cohort (n=1425) consisted of patients admitted to a traditional mixed surgical intensive care unit (SICU) from Jan.2005 - Jan.2007. The intervention cohort (n=1824) consisted of patients admitted to a newly created cardiac surgery ICU (CICU) from Jan.2007 - Sept.2008, which was staffed by 24/7 in-house consultants. Cost estimates were calculated for each patient from time of ICU admission to hospital discharge. For comparison purposes, propensity analysis was performed matching both cohorts on over twenty clinical, physiological, and surgical variables. Results: 1,182 patients (83%) per cohort were matched. Pre-operative demographics and surgical variables were similar between both cohorts. The CICU model was associated with a significant decrease in mean hospital bed, laboratory, and blood transfusion costs (Table 1). A higher mean ICU consultant salary cost offset this. Total estimated median cost was ∼14% lower in the CICU model relative to the SICU model (Table 1). Conclusions: We present a large before-after observational study examining the cost-effectiveness of 24/7 ICU consultant staffing. Our data suggests that the greater savings associated with improvement in post-operative care offsets the salary costs associated with 24/7 in-house consultants.

Survey of Physiotherapy Practice in Ontario Cardiac Surgery Intensive Care Units

2021 ◽  
pp. e20200069
Author(s):  
Anastasia N.L. Newman ◽  
Michelle E. Kho ◽  
Jocelyn E. Harris ◽  
Alison Fox-Robichaud ◽  
Patricia Solomon
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Critically Ill ◽  
Outcome Measures ◽  
Median Number ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Physiotherapy Practice

Purpose: This article describes current physiotherapy practice for critically ill adult patients requiring prolonged stays in critical care (> 3 d) after complicated cardiac surgery in Ontario. Method: We distributed an electronic, self-administered 52-item survey to 35 critical care physiotherapists who treat adult cardiac surgery patients at 11 cardiac surgical sites. Pilot testing and clinical sensibility testing were conducted beforehand. Participants were sent four email reminders. Results: The response rate was 80% (28/35). The median (inter-quartile range) reported number of cardiac surgeries performed per week was 30 (10), with a median number of 14.5 (4) cardiac surgery beds per site. Typical reported caseloads ranged from 6 to 10 patients per day pe therapist, and 93% reported that they had initiated physiotherapy with patients once they were clinically stable in the intensive care unit. Of 28 treatments, range of motion exercises (27; 96.4%), airway clearance techniques (26; 92.9%), and sitting at the edge of the bed (25; 89.3%) were the most common. Intra-aortic balloon pump and extracorporeal membrane oxygenation appeared to limit physiotherapy practice. Use of outcome measures was limited. Conclusions: Physiotherapists provide a variety of interventions with critically ill cardiac surgery patients. Further evaluation of the limited use of outcome measures in the cardiac surgical intensive care unit is warranted.

Scoring Systems for Outcome Prediction in a Cardiac Surgical Intensive Care Unit: A Comparative Study

2015 ◽  
Vol 24 (4) ◽  
pp. 327-334 ◽  
Author(s):  
Themistocles Exarchopoulos ◽  
Efstratia Charitidou ◽  
Panagiotis Dedeilias ◽  
Christos Charitos ◽  
Christina Routsi
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Clinical Outcome ◽  
Area Under Curve ◽  
Outcome Prediction ◽  
Scoring Systems ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Saps Ii

Background Most scoring systems used to predict clinical outcome in critical care were not designed for application in cardiac surgery patients. Objectives To compare the predictive ability of the most widely used scoring systems (Acute Physiology and Chronic Health Evaluation [APACHE] II, Simplified Acute Physiology Score [SAPS] II, and Sequential Organ Failure Assessment [SOFA]) and of 2 specialized systems (European System for Cardiac Operative Risk Evaluation [EuroSCORE] II and the cardiac surgery score [CASUS]) for clinical outcome in patients after cardiac surgery. Methods Consecutive patients admitted to a cardiac surgical intensive care unit (CSICU) were prospectively studied. Data on the preoperative condition, intraoperative parameters, and postoperative course were collected. EuroSCORE II, CASUS, and scores from 3 general severity-scoring systems (APACHE II, SAPS II, and SOFA) were calculated on the first postoperative day. Clinical outcome was defined as 30-day mortality and in-hospital morbidity. Results A total of 150 patients were included. Thirty-day mortality was 6%. CASUS was superior in outcome prediction, both in relation to discrimination (area under curve, 0.89) and calibration (Brier score = 0.043, χ2 = 2.2, P = .89), followed by EuroSCORE II for 30-day mortality (area under curve, 0.87) and SOFA for morbidity (Spearman ρ= 0.37 and 0.35 for the CSICU length of stay and duration of mechanical ventilation, respectively; Wilcoxon W = 367.5, P = .03 for probability of readmission to CSICU). Conclusions CASUS can be recommended as the most reliable and beneficial option for benchmarking and risk stratification in cardiac surgery patients.

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