Early Rehospitalization After Prolonged Intensive Care Unit Stay Post Cardiac Surgery: Outcomes and Modifiable Risk Factors

Manji, Rizwan A.; Arora, Rakesh C.; Singal, Rohit K.; Hiebert, Brett; Menkis, Alan H.

doi:10.1161/jaha.116.004072

Cited by 12 publications

(8 citation statements)

References 47 publications

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“…Therefore, 87 studies met the eligibility criteria and were included in this analysis (Fig. 1) [16–102]. The κ value for agreement on full text was excellent (0.90, p <0.01).…”

Section: Resultsmentioning

confidence: 99%

Hospital re‐admission after critical care survival: a systematic review and meta‐analysis

et al. 2021

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Summary Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta‐analysis to assess hospital re‐admission rates following critical care admission and to explore potential re‐admission risk factors. We searched the MEDLINE, Embase and CINAHL databases on 05 March 2020. Our search strategy incorporated controlled vocabulary and text words for hospital re‐admission and critical illness, limited to the English language. Two reviewers independently applied eligibility criteria and assessed quality using the Newcastle Ottawa Score checklist and extracted data. The primary outcome was acute hospital re‐admission in the year after critical care discharge. Of the 8851 studies screened, 87 met inclusion criteria and 41 were used within the meta‐analysis. The analysis incorporated data from 3,897,597 patients and 741,664 re‐admission episodes. Pooled estimates for hospital re‐admission after critical illness were 16.9% (95%CI: 13.3–21.2%) at 30 days; 31.0% (95%CI: 24.3–38.6%) at 90 days; 29.6% (95%CI: 24.5–35.2%) at six months; and 53.3% (95%CI: 44.4–62.0%) at 12 months. Significant heterogeneity was observed across included studies. Three risk factors were associated with excess acute care rehospitalisation one year after discharge: the presence of comorbidities; events during initial hospitalisation (e.g. the presence of delirium and duration of mechanical ventilation); and subsequent infection after hospital discharge. Hospital re‐admission is common in survivors of critical illness. Careful attention to the management of pre‐existing comorbidities during transitions of care may help reduce healthcare utilisation after critical care discharge. Future research should determine if targeted interventions for at‐risk critical care survivors can reduce the risk of subsequent rehospitalisation.

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“…Therefore, 87 studies met the eligibility criteria and were included in this analysis (Fig. 1) [16–102]. The κ value for agreement on full text was excellent (0.90, p <0.01).…”

Section: Resultsmentioning

confidence: 99%

Hospital re‐admission after critical care survival: a systematic review and meta‐analysis

et al. 2021

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“…Over the last two decades, the risk profile of patients undergoing cardiac surgery has increased significantly [ 1 , 2 ], and currently more than 1 million cardiac surgery procedures are performed annually in the United States and Europe [ 3 ]. Older patients and those with a higher degree of comorbidities are currently referred for cardiac surgery [ 4 ], and, even if such patients may benefit from cardiac surgery, they are at increased risk for perioperative complications that result in high morbidity and mortality [ 5 ]. Patients with a severely depressed left ventricular ejection fraction (LVEF < 35%) are particularly at increased risk of developing postoperative low cardiac output syndrome (LCOS) [ 6 ], which in turn is associated with higher mortality [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Levosimendan for patients with severely reduced left ventricular systolic function and/or low cardiac output syndrome undergoing cardiac surgery: a systematic review and meta-analysis

et al. 2017

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BackgroundPrevious studies have shown beneficial effects of levosimendan in high-risk patients undergoing cardiac surgery. Two large randomized controlled trials (RCTs), however, showed no advantages of levosimendan.MethodsWe performed a systematic review and meta-analysis (MEDLINE and Embase from inception until March 30, 2017), investigating whether levosimendan offers advantages compared with placebo in high-risk cardiac surgery patients, as defined by preoperative left ventricular ejection fraction (LVEF) ≤ 35% and/or low cardiac output syndrome (LCOS). The primary outcomes were mortality at longest follow-up and need for postoperative renal replacement therapy (RRT). Secondary postoperative outcomes investigated included myocardial injury, supraventricular arrhythmias, development of LCOS, acute kidney injury (AKI), duration of mechanical ventilation, intensive care unit and hospital lengths of stay, and incidence of hypotension during drug infusion.ResultsSix RCTs were included in the meta-analysis, five of which investigated only patients with LVEF ≤ 35% and one of which included predominantly patients with LCOS. Mortality was similar overall (OR 0.64 [0.37, 1.11], p = 0.11) but lower in the subgroup with LVEF < 35% (OR 0.51 [0.32, 0.82], p = 0.005). Need for RRT was reduced by levosimendan both overall (OR 0.63 [0.42, 0.94], p = 0.02) and in patients with LVEF < 35% (OR 0.55 [0.31, 0.97], p = 0.04). Among secondary outcomes, we found lower postoperative LCOS in patients with LVEF < 35% receiving levosimendan (OR 0.49 [0.27, 0.89], p = 0.02), lower overall AKI (OR 0.62 [0.42, 0.92], p = 0.02), and a trend toward lower mechanical support, both overall (p = 0.07) and in patients with LVEF < 35% (p = 0.05).ConclusionsLevosimendan reduces mortality in patients with preoperative severely reduced LVEF but does not affect overall mortality. Levosimendan reduces the need for RRT after high-risk cardiac surgery.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1849-0) contains supplementary material, which is available to authorized users.

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“…Additionally, prolonged intensive care unit (ICU) stay after cardiac surgery has a major impact on overall cost and resource utilization [2,3]. It has been also reported to simultaneously increase the incidence of rehospitalization [4].…”

Section: Introductionmentioning

confidence: 99%

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

Saraçoğlu

Ezelsoy

Saraçoğlu³

2018

Indian J Hematol Blood Transfus

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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.

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Early Rehospitalization After Prolonged Intensive Care Unit Stay Post Cardiac Surgery: Outcomes and Modifiable Risk Factors

Cited by 12 publications

References 47 publications

Hospital re‐admission after critical care survival: a systematic review and meta‐analysis

Hospital re‐admission after critical care survival: a systematic review and meta‐analysis

Levosimendan for patients with severely reduced left ventricular systolic function and/or low cardiac output syndrome undergoing cardiac surgery: a systematic review and meta-analysis

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

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