Risk factors for prolonged stay in cardiac surgery intensive care units

Abstract

The correlation between patient perioperative risk and ICU-LOS encourages the early identification of high-risk patients for prolonged hospitalization. Furthermore, the relationship between NWL and ICU-LOS allows the early identification of these patients with the use of an independent nursing tool.

Avaliação da carga de trabalho no pós-operatório de cirurgia cardíaca segundo o Nursing Activities Score

“…This variable is clearly associated with the quality of care and the workload of the nursing staff (23)(24) , in addition to representing one of the most important indicators of morbidity of patients undergoing cardiac surgery (25) . Patients with a longer length of stay in the ICU are probably more clinically unstable and severely ill (14) , and the occurrence of complications seems to greatly contribute to time spent in the ICU. One study of patients that underwent cardiac surgery showed that the presence of complications significantly increased the time of hospitalization in the ICU (26)(27) .…”

“…Studies conducted with patients in the postoperative period of cardiac surgery showed that, in the first 24 hours, the nursing workload ranged from 61.6% to 96.8% (10)(11)(12)(13) . In addition, the authors observed that, in this population, the NAS was associated with adverse outcomes such as increased length of stay in the ICU, complications and mortality (13)(14)(15) . The clinical complexity of the patient's condition, highly specific care in the postoperative period, the sophistication of the treatment regimen and daily use of circulatory and respiratory support technology are elements that can directly impact nursing workload.…”

Carga de trabalho de enfermagem: preditor de infecção relacionada à assistência à saúde na terapia intensiva?

“…The occurrence of HAI was significantly associated with admissions for clinical treatment compared to admissions for surgical treatment. The scientific literature shows that the occurrence of HAI has been associated with prolonged stay in ICU, with increased mortality, costs and overload of nursing staff, regardless of age of the patient (15)(16) . One recent study aiming to identify which variables were associated with mortality among clinical and surgical patients admitted to ICU observed among 827 admissions that, despite the patients admitted for clinical medicine presenting more HAI, these infections were independent risk factors for mortality only among patients hospitalized in surgical ICU.…”

“…The researchers of that study identified that the nurse-patient ratio was not significantly associated with pneumonia or BSI; however, length of stay in the ICU was associated with these outcomes (24) . Another study in Greece aimed to analyze which factors affected the length of stay in ICU among patients undergoing cardiac surgery, and found that patients with NAS above 61.6% upon admission are more than five times more likely to stay hospitalized in ICU for a longer time (15) . These results show that there is a relationship between length of stay in the ICU and workload.…”

Factors of Prolonged Intensive Care Unit Stay After Surgery in Patients with Type A Acute Aortic Dissection

“…So sometimes it can lead to postpone some operations [12]. In addition, patients with prolonged ICU stay after heart surgery can lead to develop poor quality of life after discharge from hospital [13]. In some study, it was found that prolonged ICU stay can increase the mortality rate, 1-year mortality as high as 34% and 3 year mortality of about 60% [14,15].…”