[Predictors of prolonged ICU stay following elective adult cardiac surgery: Monocentric retrospective study on 5 and half years]

Factors affecting duration of stay in the intensive care unit after coronary artery bypass surgery and its impact on in-hospital mortality: a retrospective study

BACKGROUND

Different risk factors affect the intensive care unit (ICU) stay after cardiac surgery. This study aimed to evaluate these risk factors.

PATIENTS AND METHODS

A retrospective analysis was conducted on clinical, operative, and outcome data from 1070 patients (mean age: 59 ± 9.8 years) who underwent isolated coronary bypass grafting CABG surgery with cardiopulmonary bypass. The outcome variable was prolonged length of stay LOS in the CICU stay (> 3 nights after CABG).

RESULTS

Univariate predictors of prolonged ICU stays included a left atrial diameter of > 4 cm (P < 0.001),chronic obstructive airway disease COPD (P = 0.005), hypertension (P = 0.006), diabetes mellitus (P = 0.009), having coronary stents (P = 0.006), B-blockers use before surgery (either because the surgery was done on urgent or emergency basis or the patients have contraindication to B-blockers use) (P = 0.005), receiving blood transfusion during surgery (P = 0.001), post-operative acute kidney injury (AKI) (P < 0.001), prolonged inotropic support of > 12 h (P < 0.001), and ventilation support of > 12 h (P < 0.001), post-operative sepsis or pneumonia (P < 0.001), post-operative stroke/TIA (P = 0.001), sternal wound infection (P = 0.002), and postoperative atrial fibrillation POAF (P < 0.001). Multivariate regression revealed that patients with anleft atrial LA diameter of > 4 cm (AOR 2.531, P = 0.003), patients who did not take B-blockers before surgery (AOR 1.1 P = 0.011), patients on ventilation support > 12 h (AOR 3.931, P =  < 0.001), patients who developed pneumonia (AOR 20.363, P =  < 0.001), and patients who developed post-operative atrial fibrillation (AOR 30.683, P =  < 0.001) were more likely to stay in the ICU for > 3 nights after CABG.

CONCLUSION

Our results showed that LA diameter > 4 cm, patients who did not take beta-blockers before surgery, on ventilation support > 12 h, developed pneumonia post-operatively, and developed POAF were more likely to have stays lasting > 3 nights. Efforts should be directed toward reducing these postoperative complications to shorten the duration of CICU stay, thereby reducing costs and improving bed availability.

Risk factors for prolonged intensive care unit stays in patients after cardiac surgery with cardiopulmonary bypass: A retrospective observational study

Objectives

Patients after cardiac surgery with cardiopulmonary bypass (CPB) require a stay in the ICU postoperatively. This study aimed to investigate the incidence of prolonged length of stay (LOS) in the ICU after cardiac surgery with CPB and identify associated risk factors.

Methods

The current investigation was an observational, retrospective study that included 395 ICU patients who underwent cardiac surgery with CPB at a tertiary hospital in Guangzhou from June 2015 to June 2017. Data were obtained from the hospital database. Binary logistic regression modeling was used to analyze risk factors for prolonged ICU LOS.

Results

Of 395 patients, 137 (34.7%) had a prolonged ICU LOS (>72.0 h), and the median ICU LOS was 50.9 h. Several variables were found associated with prolonged ICU LOS: duration of CPB, prolonged mechanical ventilation and non-invasive assisted ventilation use, PaO₂/FiO₂ ratios within 6 h after surgery, type of surgery, red blood cell infusion during surgery, postoperative atrial arrhythmia, postoperative ventricular arrhythmia (all P < 0.05).

Conclusions

These findings are clinically relevant for identifying patients with an estimated prolonged ICU LOS, enabling clinicians to facilitate earlier intervention to reduce the risk and prevent resulting delayed recovery.

Does Transfusion of Blood and Blood Products Increase the Length of Stay in Hospital?

We aimed to analyze the use of blood products in cardiac surgery and to investigate its effect on clinical outcomes. Perioperative transfusion requirement, survival and complication rates and the duration of hospitalization were noted. Patients were divided into two groups considering the duration of hospital and intensive care unit (ICU) stay. The cardiopulmonary bypass time and the cross clamp time, and the amount of used cryoprecipitate, fresh frozen plasma, platelet, red blood cell and the bleeding amount were significantly higher in groups that stayed at the hospital for > 7 days and at the ICU for > 2 days (p > 0.05). In the univariate model, to predict the patients who might stay at the hospital for more than 1 week and who might stay at the ICU for more than 3 days, we considered the significant efficacy of postoperative blood transfusion, bleeding amount, and the cardiopulmonary bypass time (p < 0.05). In the reduced multivariate model, however, we analyzed the significant-independent efficacy of the postoperative fresh frozen plasma use to determine the patients who would stay at the hospital for more than 1 week and who would stay at the ICU for more than 3 days (p < 0.05). We have concluded that increased use of blood products was associated with the cross clamp and cardiopulmonary bypass time and prolonged duration of hospital and ICU stays. In open cardiac surgeries, the use of blood products due to bleeding was identified as a predictor for staying longer than 3 days at the ICU and longer than 7 days at the hospital.

Effects of Glucose Variability on Short-Term Outcomes in Non-Diabetic Patients After Coronary Artery Bypass Grafting: A Retrospective Observational Study

BACKGROUND

Postoperative hyperglycaemia has been shown to have adverse effects on patients after coronary artery bypass grafting surgery (CABG). However, whether glucose variability has an effect on patients' outcomes is still uncertain. The aim of this study is to explore the effects of glucose variability on short-term outcomes in non-diabetic patients undergoing coronary artery bypass grafting.

METHODS

This is a retrospective observational study utilising data collected after patients had left the hospital. This study was performed on 137 non-diabetic patients undergoing coronary artery bypass grafting from January 2011 to June 2013. Blood glucose at 72hours post operation was obtained and glucose variability was measured by mean postoperative blood glucose and mean of daily difference (MODD). Short-term outcomes included duration of intensive care unit (ICU) stay, mechanical ventilation time, length of hospital stay, and occurrence of arrhythmia. Patients with mean postoperative blood glucose ≥7.00mmol/L were defined as hyperglycaemic, and patients with MODD ≥1.40mmol/L were considered to be abnormal. Outcome variables were compared between patients in euglycaemic and hyperglycaemic groups, and between patients in normal and abnormal groups.

RESULTS

In our study, patients with hyperglycaemia spent more time staying in ICU (p<0.01), and patients with large glucose variability (abnormal MODD) had higher incidences of arrhythmia (23% vs 4.2%, p<0.05). Regression analysis showed that MODD can affect occurrence of arrhythmia (p=0.004) and that mean postoperative blood glucose levels can affect duration of ICU stay (p<0.001).

CONCLUSIONS

Patients' postoperative glucose variability after CABG is an important predictor of the negative outcomes regarding duration of ICU stay and occurrence of arrhythmia. Large glucose variability can have negative effects on short-term outcomes in patients.