Development of an Open-Heart Intraoperative Risk Scoring Model for Predicting a Prolonged Intensive Care Unit Stay

Tribuddharat, Sirirat; Sathitkarnmanee, Thepakorn; Ngamsangsirisup, Kriangsak; Charuluxananan, Somrat; Hurst, Cameron; Silarat, Suparit; Lertmemongkolchai, Ganjana

doi:10.1155/2014/158051

Cited by 9 publications

(10 citation statements)

References 23 publications

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“…An OHIR score model, published in 2014, comprised six risk factors: age (≥60 years), P/F ratio (≤200 mmHg), platelet count (≤120,000/mm 3 ), inotrope/vasopressor requirement (≥2 drugs), serum potassium (≤3.2 mEq/L), and atrial fibrillation (grading ≥2). 7 All except one risk factor (ie, age ≥60 years) are manageable. The model has a total score of 7, with a score ≥3 suggesting a potentially prolonged ICU stay.…”

Section: Discussionmentioning

confidence: 99%

“…We used the same criteria for a prolonged ICU stay as our previous study (namely, a stay longer than the median). 7 …”

Section: Methodsmentioning

confidence: 99%

“…One model – the Open-Heart Intraoperative Risk (OHIR) score – considers intraoperative, manipulatable risk factors for improving anesthetic care and patient outcome. 7 The OHIR model comprises six risk factors: age (≥60 years), P a O 2 /F i O 2 (P/F) ratio (≤200 mmHg), platelet count (≤120,000/mm 3 ), inotrope/vasopressor requirement (≥2 drugs), serum potassium (≤3.2 mEq/L), and atrial fibrillation (grading ≥2; Table 1 ). Five factors in the model can be managed intraoperatively.…”

Section: Introductionmentioning

confidence: 99%

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Validation of Open-Heart Intraoperative Risk score to predict a prolonged intensive care unit stay for adult patients undergoing cardiac surgery with cardiopulmonary bypass

Tribuddharat¹,

Sathitkarnmanee²,

Ngamsaengsirisup³

et al. 2018

TCRM

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BackgroundA prolonged stay in an intensive care unit (ICU) after cardiac surgery with cardiopulmonary bypass (CPB) increases the cost of care as well as morbidity and mortality. Several predictive models aim at identifying patients at risk of prolonged ICU stay after cardiac surgery with CPB, but almost all of them involve a preoperative assessment for proper resource management, while one – the Open-Heart Intraoperative Risk (OHIR) score – focuses on intra-operative manipulatable risk factors for improving anesthetic care and patient outcome.ObjectiveWe aimed to revalidate the OHIR score in a different context.Materials and methodsThe ability of the OHIR score to predict a prolonged ICU stay was assessed in 123 adults undergoing cardiac surgery (both coronary bypass graft and valvular surgery) with CPB at two tertiary university hospitals between January 2013 and December 2014. The criteria for a prolonged ICU stay matched a previous study (ie, a stay longer than the median).ResultsThe area under the receiver operating characteristic curve of the OHIR score to predict a prolonged ICU stay was 0.95 (95% confidence interval 0.90–1.00). The respective sensitivity, specificity, positive predictive value, and accuracy of an OHIR score of ≥3 to discriminate a prolonged ICU stay was 93.10%, 98.46%, 98.18%, and 95.9%.ConclusionThe OHIR score is highly predictive of a prolonged ICU stay among intraopera-tive patients undergoing cardiac surgery with CPB. The OHIR comprises of six risk factors, five of which are manipulatable intraoperatively. The OHIR can be used to identify patients at risk as well as to improve the outcome of those patients.

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Section: Discussionmentioning

confidence: 99%

“…We used the same criteria for a prolonged ICU stay as our previous study (namely, a stay longer than the median). 7 …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Validation of Open-Heart Intraoperative Risk score to predict a prolonged intensive care unit stay for adult patients undergoing cardiac surgery with cardiopulmonary bypass

Tribuddharat¹,

Sathitkarnmanee²,

Ngamsaengsirisup³

et al. 2018

TCRM

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“…An early recognition of patients at risk of prolonged LOS was the main objective of several studies. 17 Some applications of stratifying patients based on their expected LOS include identifying patients that can be selected for fast-track protocols to minimise ICU stay or bypass it altogether, 18 providing anaesthesiologists with enough time to correct risk factors 19 and facilitating the selection of resource planning strategy based on patient risk of prolonged LOS. With the current economic climate in Oman, hospitals are left with no option but to efficiently manage their resources.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with prolonged length of stay following cardiac surgery in a major referral hospital in Oman: a retrospective observational study

et al. 2016

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ObjectivesTwo objectives were set for this study. The first was to identify factors influencing prolonged postoperative length of stay (LOS) following cardiac surgery. The second was to devise a predictive model for prolonged LOS in the cardiac intensive care unit (CICU) based on preoperative factors available at admission and to compare it against two existing cardiac stratification systems.DesignObservational retrospective study.SettingsA tertiary hospital in Oman.ParticipantsAll adult patients who underwent cardiac surgery at a major referral hospital in Oman between 2009 and 2013.Results30.5% of the patients had prolonged LOS (≥11 days) after surgery, while 17% experienced prolonged ICU LOS (≥5 days). Factors that were identified to prolong CICU LOS were non-elective surgery, current congestive heart failure (CHF), renal failure, combined coronary artery bypass graft (CABG) and valve surgery, and other non-isolated valve or CABG surgery. Patients were divided into three groups based on their scores. The probabilities of prolonged CICU LOS were 11%, 26% and 28% for group 1, 2 and 3, respectively. The predictive model had an area under the curve of 0.75. Factors associated with prolonged overall postoperative LOS included the body mass index, the type of surgery, cardiopulmonary bypass machine use, packed red blood cells use, non-elective surgery and number of complications. The latter was the most important determinant of postoperative LOS.ConclusionsPatient management can be tailored for individual patient based on their treatments and personal attributes to optimise resource allocation. Moreover, a simple predictive score system to enable identification of patients at risk of prolonged CICU stay can be developed using data that are routinely collected by most hospitals.

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“…They further noted that the existing tools were not reliable to identify patients for fast-track protocols and their model was superior to these systems. Another application was suggested by Tribuddharat and colleagues in the form of a prediction tool that can identify patients with prolonged LOS and may provide the anaesthesiologist with enough time to correct risk factors [ 28 ]. Targeting risk factors through aggressive treatment regimens prior to surgery may reduce the proportion of patients who require lengthy ICU LOS which can result in several medical, operational and financial benefits.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of factors influencing length of stay in ICU after adult cardiac surgery

Almashrafi

Elmontsri

Aylin

2016

BMC Health Serv Res

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BackgroundIntensive care unit (ICU) care is associated with costly and often scarce resources. In many parts of the world, ICUs are being perceived as major bottlenecks limiting downstream services such as operating theatres. There are many clinical, surgical and contextual factors that influence length of stay. Knowing these factors can facilitate resource planning. However, the extent at which this knowledge is put into practice remains unclear. The aim of this systematic review was to identify factors that impact the duration of ICU stay after cardiac surgery and to explore evidence on the link between understanding these factors and patient and resource management.MethodsWe conducted electronic searches of Embase, PubMed, ISI Web of Knowledge, Medline and Google Scholar, and reference lists for eligible studies.ResultsTwenty-nine papers fulfilled inclusion criteria. We recognised two types of objectives for identifying influential factors of ICU length of stay (LOS) among the reviewed studies. These were general descriptions of predictors and prediction of prolonged ICU stay through statistical models. Among studies with prediction models, only two studies have reported their implementation. Factors most commonly associated with increased ICU LOS included increased age, atrial fibrillation/ arrhythmia, chronic obstructive pulmonary disease (COPD), low ejection fraction, renal failure/ dysfunction and non-elective surgery status.ConclusionCardiac ICUs are major bottlenecks in many hospitals around the world. Efforts to optimise resources should be linked to patient and surgical characteristics. More research is needed to integrate patient and surgical factors into ICU resource planning.

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Development of an Open-Heart Intraoperative Risk Scoring Model for Predicting a Prolonged Intensive Care Unit Stay

Cited by 9 publications

References 23 publications

Validation of Open-Heart Intraoperative Risk score to predict a prolonged intensive care unit stay for adult patients undergoing cardiac surgery with cardiopulmonary bypass

Validation of Open-Heart Intraoperative Risk score to predict a prolonged intensive care unit stay for adult patients undergoing cardiac surgery with cardiopulmonary bypass

Factors associated with prolonged length of stay following cardiac surgery in a major referral hospital in Oman: a retrospective observational study

Systematic review of factors influencing length of stay in ICU after adult cardiac surgery

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