Predictors of Prolonged Stay in the Intensive Care Unit following Cardiac Surgery

The prediction of intensive care unit length of stay (ICU-LOS) could contribute to more efficient ICU resources' allocation and better planning of care among cardiac surgery patients. The aim of this study was to identify the preoperative and intraoperative predictors for prolonged cardiac surgery ICU-LOS. An observational cohort study was conducted among 150 consecutive patients, who were admitted to the cardiac surgery ICU of a tertiary hospital of Athens, Greece from September 2010 to January 2011. Multivariate regression analysis revealed that patients with increased creatinine levels preoperatively (odds ratio (OR) 3.0, P=0.049), history of atrial fibrillation (AF) (OR 6.3, P=0.012) and high EuroSCORE values (OR 2.6, P=0.017) had a significant greater probability to stay in the ICU for more than 2 days. In addition, intraoperative hyperglycemia (OR 3.0, P=0.004) was strongly associated with longer ICU-LOS. In conclusion, the high perioperative risk, the history of AF and renal dysfunction, and the intraoperative hyperglycemia are significant predictors of prolonged ICU stay. The early identification of patients at risk could allow the efficient ICU resources' allocation and the reduction of healthcare costs. This would contribute to nursing care planning depending on the availability of healthcare personnel and ICU bed capacity.

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Derivation and Validation of a Clinical Model to Predict Intensive Care Unit Length of Stay After Cardiac Surgery

Journal of the American Heart Association ◽

10.1161/jaha.120.017847 ◽

2020 ◽

Vol 9 (21) ◽

Cited By ~ 1

Author(s):

Louise Y. Sun ◽

Anan Bader Eddeen ◽

Marc Ruel ◽

Erika MacPhee ◽

Thierry G. Mesana

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Clinical Judgment ◽

Validation Cohort ◽

Unit Length ◽

Intensive Care Unit Length ◽

Prolonged Stay ◽

C Statistic

Background Across the globe, elective surgeries have been postponed to limit infectious exposure and preserve hospital capacity for coronavirus disease 2019 (COVID‐19). However, the ramp down in cardiac surgery volumes may result in unintended harm to patients who are at high risk of mortality if their conditions are left untreated. To help optimize triage decisions, we derived and ambispectively validated a clinical score to predict intensive care unit length of stay after cardiac surgery. Methods and Results Following ethics approval, we derived and performed multicenter valida tion of clinical models to predict the likelihood of short (≤2 days) and prolonged intensive care unit length of stay (≥7 days) in patients aged ≥18 years, who underwent coronary artery bypass grafting and/or aortic, mitral, and tricuspid value surgery in Ontario, Canada. Multivariable logistic regression with backward variable selection was used, along with clinical judgment, in the modeling process. For the model that predicted short intensive care unit stay, the c‐statistic was 0.78 in the derivation cohort and 0.71 in the validation cohort. For the model that predicted prolonged stay, c‐statistic was 0.85 in the derivation and 0.78 in the validation cohort. The models, together termed the CardiOttawa LOS Score , demonstrated a high degree of accuracy during prospective testing. Conclusions Clinical judgment alone has been shown to be inaccurate in predicting postoperative intensive care unit length of stay. The CardiOttawa LOS Score performed well in prospective validation and will complement the clinician's gestalt in making more efficient resource allocation during the COVID‐19 period and beyond.

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Causes influencing the length of stay of cardiac surgery patients in the intensive care unit

Health & Research Journal ◽

10.12681/healthresj.19279 ◽

2015 ◽

Vol 1 (1) ◽

pp. 40

Author(s):

Nikoleta Dimitropoulou ◽

Aggeliki Stamou ◽

Christina Marvaki

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Coronary Artery ◽

Demographic Characteristics ◽

Average Hospital ◽

Prolonged Stay ◽

Icu Stay ◽

History Of ◽

Prolonged Icu Stay

Introduction: The incidence of postoperative morbidity has increased, a fact which may lead to prolonged hospitalization of the patient in the Intensive Care Unit (ICU) and generally in the hospital.Aim: The aim of the present study was to explore the complications after cardiac surgery responsible for the prolonged stay of patients in the ICU.Material and method: The studied sample consisted of 80 patients who were hospitalized in the Intensive Care Unit General Hospital of Athens from January 2013 to June 2014. For data collection a special registration form with information coming from the medical records of patients was used. Data analysis was performed by the IBM SPSS 21.0 (Statistical Package for Social Sciences).Results: Regarding to demographic characteristics Regarding the demographic characteristics and medical history of the studied sample, the majority were male (58.7%, n=47), with a mean age of 73 years and an average hospital stay of 3.3 days. The major causes of prolonged ICU stay was respiratory failure (20%, n=16), arrhythmias (17.5%, n = 14), bleeding (15%, n=12), myocardial infarction (11.3%, n=9), and pulmonary edema (10%,n=8). Τhe bivariate analysis showed statistical relationship to the level of 0,20 (p<0,20) between the prolonged ICU stay and age, coronary artery disease as the cause of entry, coronary artery bypass, diabetes melitus and chronic obstructive pulmonary disease.Conclusion: Patients with a history of heart failure, diabetes or obstructive pulmonary disease seems to have a greater chance for a prolonged ICU stay after cardiac surgery. Early recognition of demographic and clinical factors that may lead to the prolonged ICU stay can provide very important information about how to improve perioperative care of the patient.

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Association of Length of Stay at Emergency Services in the Outcome of Admitted Patients

10.21203/rs.2.14888/v1 ◽

2019 ◽

Author(s):

RP Neupane ◽

S Raut ◽

TM Shrestha ◽

R Aacharya

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Emergency Services ◽

Unit Length ◽

University Teaching ◽

Cross Sectional ◽

Prolonged Stay ◽

Icu Outcome ◽

Ultimate Outcome

Abstract Background: Access block and overcrowding leading to prolonged stay in emergency room is a common problem of Emergency services of Tribhuvan University Teaching Hospital (TUTH) Kathmandu. Those patients who stayed longer in emergency department might affect continuing care and the ultimate outcome of patients. Study aims to evaluate the association of emergency services length of stay and outcome of admitted patients in wards or Intensive Care Unit at the predefined cut-off value of 6 hour. Methods: It was a prospective cross sectional comparative study done in TUTH, Kathmandu. Data were collected from records from emergency services, wards, ICU and hospital record section from October, 2018 to April, 2019. Adult patients were grouped in to two groups; Emergency services to wards (ES to Wards) and Emergency services to ICU (ES to ICU). Outcome was compared between those admitted within 6hr and those admitted after 6hr of stay in emergency services. Results: A total of 2,059 patients were enrolled over 6 months. Out of them, Male were 55.5% and 42.6% patients were at the age of equal to or above 60 years. Total admitted patients who stayed equal to or less than 6 hr in emergency services was 26.7%. It was found that there was no significant association between Emergency services length of stay (ESLOS) and outcome of admitted total patients (p= 0.160) as well as in ICU (p= 0.559) or Ward admitted patients (p= 0.361). Age was found independent predictor for outcome (p= <0.01). Association of ESLOS and age was also found statistically significant (p= 0.02). Conclusions: Emergency service length of stay is not predictor for outcome of admitted patients. Key words: Emergency services, intensive care unit, length of stay, mortality.

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