Lactate levels after major cardiac surgery are associated with hospital length of stay

Background: Extubation failure (ExtF) is associated with prolonged hospital length of stay and mortality in adult cardiac surgery patients postoperatively. In this population, ExtF-related variables such as the arterial partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2/FiO2), rapid shallow breathing index, cough strength, endotracheal secretions and neurological function have been sparsely researched. Aim: To identify variables that are predictive of ExtF and related outcomes. Method: Prospective observational longitudinal study. Consecutively presenting patients ( n=205) undergoing open-heart cardiac surgery and admitted to the Cardiosurgical Intensive Care Unit (CICU) were recruited. The clinical data were collected at CICU admission and immediately prior to extubation. ExtF was defined as the need to restart invasive or non-invasive mechanical ventilation while the patient was in the CICU. Results: The ExtF incidence was 13%. ExtF related significantly to hospital mortality, CICU length of stay and total hospital length of stay. The risk of ExtF decreased significantly, by 93% in patients with good neurological function and by 83% in those with a Rapid Shallow Breathing Index of ≥57 breaths/min per litre. Conversely, ExtF risk increased 27 times when the PaO2/FiO2 was <150 and 11 times when it was ≥450. Also, a reassuring PaO2/FiO2 value may hide critical pulmonary or extra-pulmonary conditions independent from alveolar function. Conclusion: The decision to extubate patients should be taken after thoroughly discussing and combining the data derived from nursing and medical clinical assessments. Extubation should be delayed until the patient achieves safe respiratory, oxygenation and haemodynamic conditions, and good neurocognitive function.

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Preoperative hospital length of stay as a modifiable risk factor for mediastinitis after cardiac surgery

Journal of Cardiothoracic Surgery ◽

10.1186/1749-8090-8-45 ◽

2013 ◽

Vol 8 (1) ◽

Cited By ~ 12

Author(s):

Stephane Leung Wai Sang ◽

Rakesh Chaturvedi ◽

Ahsan Alam ◽

Gordan Samoukovic ◽

Benoit de Varennes ◽

...

Keyword(s):

Cardiac Surgery ◽

Risk Factor ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Modifiable Risk Factor

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Preoperative walking recommendation for non-cardiac surgery patients to reduce the length of hospital stay: a randomized control trial

BMC Sports Science Medicine and Rehabilitation ◽

10.1186/s13102-021-00317-w ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Olga L. Cortés ◽

Mauricio Herrera-Galindo ◽

Claudia Becerra ◽

Mónica Rincón-Roncancio ◽

Camilo Povea-Combariza ◽

...

Keyword(s):

Cardiac Surgery ◽

Length Of Stay ◽

Waiting Time ◽

Length Of Hospital Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Rank Test ◽

Early Ambulation ◽

Log Rank Test ◽

The Impact

Abstract Background Even though the importance of preparing patients for a surgical event is recognized, there are still gaps about the benefit of improving functional capacity by walking during the waiting time among patients scheduled for non-cardiac surgery. The aim of this study was to evaluate the impact of pre-surgical walking in-hospital length of stay, early ambulation, and the appearance of complications after surgery among patients scheduled for non-cardiac surgery. Methods A two-arm, single- blinded randomized controlled trial was developed from May 2016 to August 2017. Eligible outpatients scheduled for non-cardiac surgery, capable of walking, were randomized (2:1 ratio) to receive a prescription of walking 150 min/week during the whole pre-surgical waiting time (n = 249) or conventional care (n = 119). The primary outcome was the difference in hospital length of stay, and secondary results were time to first ambulation during hospitalization, description of ischemic events during hospitalization and after six months of hospital discharge, and the walking continuation. We performed an intention to treat analysis and compared length of stay between both groups by Kaplan–Meier estimator (log-rank test). Results There were no significant differences in the length of hospital stay between both groups (log-rank test p = 0.367) and no differences in the first ambulation time during hospitalization (log-rank test p = 0.299). Similar rates of postoperative complications were observed in both groups, but patients in the intervention group continued to practice walking six months after discharge (p < 0.001). Conclusion Our study is the first clinical trial evaluating the impact of walking before non-cardiac surgery in the length of stay, early ambulation, and complications after surgery. Prescription of walking for patients before non-cardiac surgery had no significant effect in reducing the length of stay, and early ambulation. The results become a crucial element for further investigation. Trial registration: PAMP-Phase2 was registered in ClinicalTrials.gov NCT03213496 on July 11, 2017.

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Sedative use of Dexmedetomidine vs. Propofol after Cardiac Surgery: A critical review and meta-analysis.

10.21203/rs.2.230/v2 ◽

2019 ◽

Author(s):

Hesham Abowali ◽

Matteo Paganini ◽

Garrett A Enten ◽

Ayman Elbadawi ◽

Enrico Camporesi

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Length ◽

Time Dependent ◽

Hospital Length Of Stay ◽

Ventilation Time ◽

Mechanical Ventilation Time

Abstract Abstract Background : The use of dexmedetomidine for sedation post-cardiac surgery is controversial compared to the use of propofol. Methods : A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was performed for up to July 2019. Trials evaluating the efficacy of dexmedetomidine versus propofol in the postoperative sedation of cardiac surgery patients were selected. Primary study outcomes were classified as time-dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and the hospital) and non-time dependent (delirium, bradycardia, and hypotension). Results : Our final analysis included 11 RCTs published between 2003 and 2019 and involved a total of 1184 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.61, 95% Confidence Interval (CI): -1.06 to -0.16, p=0.008), however no difference in mechanical ventilation time was observed (SMD= -0.72, 95% CI: -1.60 to 0.15, N.S.). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.70, 95% CI: -0.98 to -0.42, p=0.0005) this did not translate into a reduced hospital length of stay (SMD= -1.13, 95% CI: -2.43 to 0.16, N.S). For non-time dependent factors: incidence of delirium was unaffected between groups (OR: 0.68, 95% CI: 0.43 to 1.06, N.S.), while the propofol group of patients had higher rates of bradycardia (OR: 3.39, 95% CI: 1.20 to 9.55, p=0.020) and hypotension (OR: 1.68, 95% CI: 1.09 to 2.58, p=0.017). Conclusion : Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former does not contribute to an overall reduction in hospital length of stay or an overall improvement in postoperative outcomes for heart valve surgery and CABG patients. Time-dependent outcomes confounded by several factors including variability in staff, site-protocols, and complication rates between individual surgical cases. Keywords: dexmedetomidine; propofol; cardiac surgery; postoperative sedation.

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Postoperative cardiac surgery complications and hospital length of stay

Revista de Enfermagem UFPE on line ◽

10.5205/1981-8963-v12i8a234846p2105-2112-2018 ◽

2018 ◽

Vol 12 (8) ◽

pp. 2105

Author(s):

Alexandre Lins Werneck ◽

Ligia Marcia Contrin ◽

Lucia Marinilza Beccaria ◽

Gabriela Taparo De Castro ◽

Carolina Varine Teixeira ◽

...

Keyword(s):

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Cross Sectional Study ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Cross Sectional ◽

Cardiac Surgery Complications ◽

Set Up ◽

Previous Disease

RESUMOObjetivo: associar as principais complicações com pacientes submetidos à cirurgia cardíaca e o tempo de internação. Método: estudo quantitativo, transversal, descritivo e correlacional, para identificar os registros médicos de pacientes submetidos a cirurgias cardíacas e aqueles no pós-operatório na Unidade de Terapia Intensiva. O teste de Regressão Linear Multivariada foi utilizado para a análise e a previsão de independência entre as variáveis. Resultados: dos 103 pacientes submetidos a cirurgias cardíacas, 26 apresentaram complicações pós-operatórias. As complicações mais prevalentes foram cardíacas, pulmonares e infecciosas. Nove pacientes morreram. A doença anterior mais prevalente foi hipertensão arterial sistêmica. Em relação aos dias de hospitalização, o predomínio foi de um a três dias, seguido de três a seis dias. Conclusão: a revascularização miocárdica foi a principal cirurgia realizada, seguida de endarterectomia e as complicações observadas foram cardíacas, seguidas das pulmonares. A duração hospitalar dos pacientes variou de um a três dias. Este estudo mostrou que é imprescindível o planejamento da alta do paciente o mais precocemente possível para a diminuição do tempo de internação e possíveis complicações. Descritores: Complicações; Cirurgias Cardíacas; Pacientes; Tempo de Internação; Tempo de Internação; Alta do Paciente; Unidade de Terapia Intensiva.ABSTRACT Objective: to associate the main complications experienced by patients submitted to cardiac surgery and the length of stay in a Cardiac ICU. Method: this was a quantitative, cross-sectional study using descriptive and correlation designs. We identified medical records of patients undergoing cardiac surgeries and those who were in the postoperative period in the Intensive Care Unit. Multivariate Linear Regression test was used for THE analysis and THE prediction of independence between variables. Results: twenty-six out of 103 patients submitted to cardiac surgeries presented postoperative complications. The most prevalent complications were cardiac, pulmonary, and infectious ones. Nine patients died. The most prevalent previous disease was systemic arterial hypertension. Regarding the hospital length of stay, the predominance was ONE to THREE days, followed by THREE to six days. Conclusion: The hospital length of stay ranged from ONE to THREE days long. This STUDY showed that planning is essential to set up the patient’s discharge as early as possible, as well as to reduce the hospital length of stay and potential complications. Descriptor: Complications; Thoracic Surgery; Patients; Length of Stay; Discharge Plannings; Intensive Care Unit.RESUMENObjetivo: Asociar las principales complicaciones con pacientes sometidos a la cirugía y con el tempo de internación. Método: Estudio cuantitativo, transversal, descriptivo y correlacional del banco de datos del hospital para identificar los registros médicos de pacientes sometidos a cirugías torácicas y de aquellos en el postoperatorio en la Unidad de Cuidados Intensivos. Se utilizó la prueba de Regresión Lineal Múltiple para análisis y predicción de independencia entre las variables. Resultados: De los 103 pacientes sometidos a cirugías torácicas, 26 presentaron complicaciones postoperatorias. Las complicaciones más prevalentes fueron las cardíacas, las pulmonares y las infecciosas. Nueve pacientes murieron. La enfermedad anterior más prevalente ha sido la hipertensión arterial sistémica. Acerca de los días de hospitalización, el período predominante fue de UNO a TRES días, seguido de TRES a SEIS días. Conclusión: La cirugía de revascularización coronaria ha sido la principal cirugía, seguida de la endarterectomía, y las complicaciones observadas fueron las cardíacas, seguidas de las pulmonares. El tiempo de internación de los pacientes varió de UNO a TRES días. Eso ESTUDIO ha mostrado que es imprescindible planificar el egreso del paciente lo más temprano posible, para reducción del tiempo de internación y de las posibles complicaciones. Descriptores: Complicaciones; Cirurgía Torácica; Pacientes; Tiempo de Internación; Alta del Paciente; Unidades de Cuidados Intensivos.

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