Effect of Prolonged Intensive Care Stay on Survival following Coronary Surgery

Abstract

The aim of the study was to examine midterm survival in patients who required prolonged recovery in the intensive care unit. The 5,186 consecutive patients who underwent isolated coronary surgery between April 1997 and March 2002 were retrospectively analyzed. Patients were classified as having prolonged (>3 days) or normal (<or=3 days) stay in the intensive care unit. Patient records were matched to the National Health Service Strategic Tracing Service which records all-cause mortality in the UK. Case-mix was controlled for by constructing a propensity score from core patient characteristics, which was included along with the comparison variable in a multivariable analysis of outcome. Prolonged intensive care unit stay was recorded in 475 (9.16%) patients. Mortality was 9.14% during the study period with a total follow-up of 19,618 patient-years (mean, 3.8 years). Adjusted 5-year survival was 78.0% for prolonged intensive care unit stay vs. 90.7% for normal stay, with an adjusted hazard ratio for midterm mortality of 2.6 (p<0.001). Midterm mortality was significantly higher in patients with a prolonged intensive care unit stay following coronary bypass.

The influence of prolonged intensive care stay on quality of life, recovery, and clinical outcomes following cardiac surgery: A prospective cohort study

“…3 days is used in 6 other studies. 16,[29][30][31][32][33] In the current study, ! 3 days was chosen as the cutoff point based on local ICU stay duration.…”

“…The present study also supports previous findings that prolonged ICU stay is associated with higher morbidity and mortality. 4,8,9,16 To reduce the confounder bias for mortality and morbidity outcomes we performed propensity matching. However, mortality in the long ICU remained higher than the normal ICU group.…”

“…13,14 There are several well-established preoperative risk stratification scoring systems in cardiac surgery, such as the European Score for Cardiac Risk Evaluation (EuroSCORE) and Society of Thoracic Surgeons score, none of which predict prolonged ICU stay or QOL. 15,16 A recent systematic review by our group 17 concluded that postoperative QOL after prolonged ICU stay following cardiac surgery is variable and that reported QOL outcomes are inconsistent across the reported studies.…”