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

Diab, Mohammad; Bilkhu, Rajdeep; Soppa, Gopal; Edsell, Mark; Fletcher, Nick; Heiberg, Johan; Royse, Colin; Jahangiri, Marjan

doi:10.1016/j.jtcvs.2018.05.076

Cited by 25 publications

(28 citation statements)

References 30 publications

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“…This study will provide one of the highest density of postoperative PROM data in existing cardiac surgery literature 3 , and it will characterize the variability in individual recovery processes with a high temporal resolution. This study will be important in closing knowledge gaps around patient-level variations in trajectories because prior studies have mostly focused on changes in PROM scores at a limited number of time points 3 or reporting group-level aggregate of longitudinal recovery data 7,22 . Because recovery is an individual, variable, and time-dependent process, we designed our data collection and analytical approach to capture such features important to recovery.…”

Section: Discussionmentioning

confidence: 99%

Protocol for Project Recovery: Cardiac Surgery - Leveraging Digital Platform for Efficient Collection of Longitudinal Patient-Reported Outcome Data Towards Improving Postoperative Recovery

Mori

Brooks

Spatz

et al. 2020

Preprint

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Introduction Improving postoperative patient recovery after cardiac surgery is a priority, but our current understanding of individual variations in recovery and factors associated with poor recovery is limited. We are using a health-information exchange platform to collect patient-reported outcome measures (PROMs) and wearable device data to phenotype recovery patterns in the 30-day period after cardiac surgery hospital discharge, to identify factors associated with these phenotypes and to investigate phenotype associations with clinical outcomes. Methods and analysis We designed a prospective cohort study to enroll 200 patients undergoing valve, coronary artery bypass graft, or aortic surgery at a tertiary center in the U.S. We are enrolling patients postoperatively after the intensive care unit (ICU) discharge, and delivering electronic surveys directly to patients every 3 days for 30 days after hospital discharge. We will conduct medical record reviews to collect patient demographics, comorbidity, operative details and hospital course using the Society of Thoracic Surgeons (STS) data definitions. We will use phone interview and medical record review data for adjudication of survival, readmission, and complications. We will apply group-based trajectory modeling to the time-series PROM and device data to classify patients into distinct categories of recovery trajectories. We will evaluate whether certain recovery pattern predicts death or hospital readmissions, as well as whether clinical factors predict a patient having poor recovery trajectories. We will evaluate whether early recovery patterns predict the overall trajectory at the patient-level. Ethics and dissemination The Yale Institutional Review Board approved this study. Following the description of the study procedure, we obtain written informed consent from all study participants. The consent form states that all personal information, survey response, and any medical records are confidential, will not be shared, and are stored in an encrypted database.

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Section: Discussionmentioning

confidence: 99%

Protocol for Project Recovery: Cardiac Surgery - Leveraging Digital Platform for Efficient Collection of Longitudinal Patient-Reported Outcome Data Towards Improving Postoperative Recovery

Mori

Brooks

Spatz

et al. 2020

Preprint

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“…20 Svipaður munur sást fyrir MACCE-fría lifun (p<0,0001) og var það einnig sambaerilegt og í öðrum erlendum rannsóknum. 21 Helsti styrkleiki þessarar rannsóknar er að margar breytur voru skráðar fyrir hvern sjúkling og er gagnagrunnurinn því mjög ítarlegur. Auk þess lágu upplýsingar um legutíma á sjúkrahúsi fyrir hjá naer öllum sjúklingum og eftirfylgd sjúklinganna með tilliti til lifunar var nánast 100%.…”

Section: Umraeðurunclassified

Algengi og áhættuþættir lengdrar dvalar á gjörgæsludeild eftir kransæðahjáveituaðgerð

Gunnarsdottir

Heimisdottir

et al. 2020

LBL

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Á Íslandi eru gerðar 100-150 kransaeðahjáveituaðgerðir á ári. Fyrstu nóttina eftir aðgerð hafa allir sjúklingar hingað til dvalist á gjörgaesludeild til eftirlits. Sumir sjúklingar þurfa þó lengri dvöl vegna umfangsmeiri gjörgaeslumeðferðar eftir aðgerðina eða fylgikvilla. Á Landspítala eru tvaer gjörgaesludeildir sem rúma alls 22 sjúklinga, en undanfarin tvö ár hefur ekki verið unnt að nýta nema 12-13 pláss vegna skorts á hjúkrunarfraeðingum. Á sama tíma hefur baeði sjúklingum og legudögum á gjörgaesludeildinni fjölgað, einkum vegna bráðainnlagna, sem getur valdið því að valkvaeðum gjörgaesluinnlögnum er frestað. 1 Árið 2018 var rúmlega þriðjungi allra hjartaaðgerða frestað vegna plássleysis á gjörgaeslu.Tímalengd gjörgaesludvalar eftir kransaeðahjáveitu er mismunandi og fer meðal annars eftir innlagnarástaeðu, gangi skurðaðgerðar og hvort fylgikvillar koma upp eftir aðgerð. Í erlendum greinum hafa eftirtaldir áhaettuþaettir lengdrar gjörgaesludvalar verið nefndir til sögunnar: hár aldur, skert útstreymisbrot (ejection fraction) vinstri slegils og langvinnir lungnasjúkdómar. 2,3 Einnig Algengi og áhaettuþaettir lengdrar dvalar á gjörgaesludeild eftir kransaeðahjáveituaðgerð Á G R I P INNGANGUR Til að hámarka nýtingu gjörgaeslurýma er mikilvaegt að þekkja algengi og áhaettuþaetti lengdrar dvalar á gjörgaesludeild eftir kransaeðahjáveituaðgerð en slík rannsókn hefur ekki verið gerð áður hér á landi. EFNIVIÐUR OG AÐFERÐIR Rannsóknin var afturskyggn og náði til allra sjúklinga sem gengust undir kransaeðahjáveituaðgerð á Landspítala á árunum 2001-2018. Skráðar voru upplýsingar um heilsufar sjúklinganna, aðgerðartengda þaetti og fylgikvilla eftir aðgerðina. Sjúklingar sem lágu á gjörgaeslu í eina nótt voru bornir saman við þá sem lágu þar tvaer naetur eða lengur. Lifun var áaetluð með aðferð Kaplan-Meiers. Forspárþaettir dvalarlengdar á gjörgaeslu voru fundnir með lógistískri aðhvarfsgreiningu og niðurstöðurnar notaðar til að útbúa reiknivél sem áaetlar líkur á lengri gjörgaesludvöl. NIÐURSTÖÐURAf 2177 sjúklingum þurftu 20% gjörgaesludvöl í tvaer naetur eða lengur. Sjúklingar sem lágu tvaer eða fleiri naetur á gjörgaeslu voru oftar konur (23% á móti 16%, p=0,001). Þessir sjúklingar höfðu einnig oftar áhaettuþaetti kransaeðasjúkdóms og fyrri sögu um aðra hjartasjúkdóma eins og hjartabilun, lokusjúkdóma og skert útstreymisbrot vinstri slegils. Auk þess var EuroSCORE II gildi þeirra haerra (4,7 á móti 1,9, p<0,001) og höfðu þeir oftar skerta nýrnastarfsemi fyrir aðgerð (30% á móti 16%, p<0,001) og þurftu frekar á bráðaaðgerð að halda (18% á móti 2%, p<0,001). Sjúklingar sem dvöldu tvaer naetur eða lengur höfðu haerri tíðni skammog langtímafylgikvilla og verri langtímalifun en sjúklingar í viðmiðunarhópi (78% á móti 93% lifun 5 árum frá aðgerð, p<0,0001). Sjálfstaeðir áhaettuþaettir lengri gjörgaesludvalar voru aldur, kyn, EuroSCORE II gildi, fyrri saga um aðra hjartasjúkdóma, skert nýrnastarfsemi og bráðaaðgerð. ÁLYKTANIRFimmti hver sjúklingur þarf gjörgaesludvöl í tvaer eða fleiri naetur eftir kransaeðahjáveitu á Landsp...

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“…Indeed, in several countries, length of stay is a measure of the efficacy of the national health service (Kulinskaya et al, 2005) and has been proposed as an important indicator for patients' quality of life (Diab et al, 2018). Furthermore, length of stay has been highlighted as a key outcome variable to consider in intermediate care services .…”

Section: Introductionmentioning

confidence: 99%

Predictive factors of a prolonged length of stay in a community Nursing‐Led unit: A retrospective cohort study

Zeffiro

Sanson

Welton

et al. 2020

Journal of Clinical Nursing

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Aims and objectives: To describe the care provided to patients admitted into a community Nursing-Led inpatient unit and to identify factors predicting a length of stay exceeding an established threshold. Background: Few studies have been conducted to describe the care provided in a Nursing-Led unit. No studies have investigated factors affecting length of stay in these services. Design: Retrospective cohort study. Methods: Consecutive patients admitted to a community Nursing-Led unit between 2009-2015 were enrolled. Sociodemographic, medical and nursing care (diagnoses and activities) variables were collected from electronic health records. Descriptive analysis and a backward stepwise logistic regression model were applied. The study followed the STROBE guidelines. Results: The study enrolled 904 patients (mean age: 77.7 years). The most frequent nursing diagnoses were bathing self-care deficit and impaired physical mobility. The nursing activities most provided were enteral medication administration and vital signs measurement. Approximately 37% of the patients had a length of stay longer than the established threshold. Nine covariates, including being discharged to home, having an impaired memory nursing diagnosis or being treated for advanced wound care, were found to be independent predictors of prolonged length of stay. Variables related to medical conditions did not affect the length-of-stay threshold. Conclusions: The length of stay in the community Nursing-Led unit was mainly predicted by conditions related to sociodemographic factors, nursing complexity and functional status. This result confirms that the medical and nursing needs of a community Nursing-Led unit population substantively differ from those of hospitalised acute patients.

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

Cited by 25 publications

References 30 publications

Protocol for Project Recovery: Cardiac Surgery - Leveraging Digital Platform for Efficient Collection of Longitudinal Patient-Reported Outcome Data Towards Improving Postoperative Recovery

Protocol for Project Recovery: Cardiac Surgery - Leveraging Digital Platform for Efficient Collection of Longitudinal Patient-Reported Outcome Data Towards Improving Postoperative Recovery

Algengi og áhættuþættir lengdrar dvalar á gjörgæsludeild eftir kransæðahjáveituaðgerð

Predictive factors of a prolonged length of stay in a community Nursing‐Led unit: A retrospective cohort study

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