Factors influencing prolonged icu stay after open heart surgery

Abstract

Background:There are different risk factors that affect the intensive care unit (ICU) stay after cardiac surgery.Objectives:The aim of this study was to evaluate possible risk factors influencing prolonged ICU stay in a large referral hospital.Patients and Methods:We conducted a case-control study to determinate causes of prolonged ICU stay in 280 adult patients undergoing cardiac surgery in a tertiary care center for cardiovascular patients, Tehran, Iran. These patients were divided into two groups according to ICU stay ≤ 96 and > 96 hours. We evaluated perioperative risk factors of ICU stay > 96 hours.Results:Among the 280 patients studied, 184 (65.7%) had stayed ≤ 96 hours and 96 (34.3%) had stayed > 96 hours in ICU. Frequency of prolonged ICU stay was 34.2% in patients undergoing coronary artery bypass graft (CABG), 30.8% in patients with valve surgery, and 44.8% in patients with CABG plus valve surgery. Patients with > 96 hours of ICU stay received more blood transfusion and intravenous inotropes. They also had longer anesthesia, cardiopulmonary bypass, and postoperative intubation time. There were higher incidence of postoperative tamponade, re-exploration, re-intubation, hemodialysis, and hypotension in this group (P < 0.05 for all comparisons).Conclusions:In this study, about one-third of patients had prolonged ICU stay. Factors influencing prolonged ICU stay were medical and some non-medical factors. In the present study, up to 30% of the patients had a prolonged ICU stay of > 96 hours. Additional data from well-designed investigations are needed for further assessment of the factors influencing prolonged ICU stay after cardiac surgery.

Prognostic factors influencing prolonged ventilation after open mitral valve surgery

“…A study by Azarfarin (2014), revealed that patients with heart failure functional classes III and IV increased ICU length of stay, postoperative stroke incidence and postoperative kidney failure. 12 In this study the status of patients with clinical heart failure functional class IV was not found. This is likely because patients with functional IV grade heart failure rarely achieve optimal conditions for surgery.…”

“…This finding resembles the results of Azarfarin's (2014) study of factors related to the increased of length of stay after open heart surgery which stated that age >50 years, duration of surgery and CPB duration had a significant effect on ICU length of stay. 12 Another study that discussed the duration of CPB was carried out by Salis et al (2008) which states that CPB duration is an independent predictor of postoperative cardiac morbidity and mortality. The type of morbidity studied by Salis et al are postoperative blood loss, length of ICU treatment, total length of hospital stays, multiple RBC transfusions, surgery due to bleeding, respiratory, neurological, infection, and kidney complications.…”

Inotropic Requirement in Patients Undergoing Coronary Artery Bypass Grafting (CABG) in RSUP Dr. Hasan Sadikin Bandung in 2014-2016

“…Other research showed that in elderly age group, low LVEF, the duration of CPB, and repetitive surgeries helped play a role in long hospitalization in intensive care unit. Moreover, it was found in patients with LVEF less than 40% of the time required is much longer to achieve stable hemodynamics and weaned from mechanic ventilation so as to extend the period of treatment in the intensive care room [6] [13].…”

Associação da função pulmonar e capacidade funcional com o tempo de ventilação mecânica invasiva após cirurgia de revascularização do miocárdio

“…Estudos sugerem que a ventilação mecânica invasiva (VMI) prolongada resulta em maiores índices de mortalidade, 6 além da diminuição da capacidade pulmonar e aumento da chance de complicações pulmonares 7,4 . Em contrapartida, um tempo menor de VMI reduz o tempo de permanência hospitalar por acelerar a fase de recuperação pós-operatória e a mobilidade do paciente 8 . Por isso, torna-se importante identificar fatores que possam contribuir para melhorar esse desfecho.…”