Outcomes After Prolonged ICU Stays in Postoperative Cardiac Surgery Patients.
Journal
Federal practitioner : for the health care professionals of the VA, DoD, and PHS
ISSN: 1078-4497
Titre abrégé: Fed Pract
Pays: United States
ID NLM: 9500574
Informations de publication
Date de publication:
Nov 2022
Nov 2022
Historique:
entrez:
16
3
2023
pubmed:
17
3
2023
medline:
17
3
2023
Statut:
ppublish
Résumé
Prolonged postoperative intensive care unit (ICU) stays are common after cardiac surgery and are associated with poor outcomes. There are few studies evaluating how risk factors associated with mortality may change during prolonged ICU stays or how mortality may vary with length of stay. We evaluated operative and long-term mortality in post-cardiac surgery patients after prolonged ICU stays at 7, 14, 21, and 28 days and factors associated with mortality. We included University of Michigan Medical Center cardiac surgery patients with ≥ 7 postoperative days in the ICU. We determined factors associated with hospital mortality at 7, 14, 21, and 28 days of ICU stay using logistic regression, and among hospital survivors, we determined the factors associated with long-term mortality using Cox regression. Of 8309 ICU admissions from cardiac surgery, 1174 (14%) had ICU stays > 7 days. Operative mortality was 11%, 18%, 22%, and 35% for the 7-, 14-, 21-, and 28-day groups, respectively. Mechanical ventilation on the day of assessment was associated with increased odds ratios of operative mortality in all models. Of the 1049 (89%) hospital survivors, 420 (40%) died by late follow-up. Median (IQR) Cox model survival was 10.7 (0.7) years. Longer ICU stays, postoperative pneumonia, and elevated discharge blood urea nitrogen were associated with increased hazard of dying; whereas higher discharge platelet count and cardiac transplant were protective. Both operative and late mortality increased as the duration of a ICU stay increased after cardiac surgery.
Sections du résumé
Background
UNASSIGNED
Prolonged postoperative intensive care unit (ICU) stays are common after cardiac surgery and are associated with poor outcomes. There are few studies evaluating how risk factors associated with mortality may change during prolonged ICU stays or how mortality may vary with length of stay. We evaluated operative and long-term mortality in post-cardiac surgery patients after prolonged ICU stays at 7, 14, 21, and 28 days and factors associated with mortality.
Methods
UNASSIGNED
We included University of Michigan Medical Center cardiac surgery patients with ≥ 7 postoperative days in the ICU. We determined factors associated with hospital mortality at 7, 14, 21, and 28 days of ICU stay using logistic regression, and among hospital survivors, we determined the factors associated with long-term mortality using Cox regression.
Results
UNASSIGNED
Of 8309 ICU admissions from cardiac surgery, 1174 (14%) had ICU stays > 7 days. Operative mortality was 11%, 18%, 22%, and 35% for the 7-, 14-, 21-, and 28-day groups, respectively. Mechanical ventilation on the day of assessment was associated with increased odds ratios of operative mortality in all models. Of the 1049 (89%) hospital survivors, 420 (40%) died by late follow-up. Median (IQR) Cox model survival was 10.7 (0.7) years. Longer ICU stays, postoperative pneumonia, and elevated discharge blood urea nitrogen were associated with increased hazard of dying; whereas higher discharge platelet count and cardiac transplant were protective.
Conclusions
UNASSIGNED
Both operative and late mortality increased as the duration of a ICU stay increased after cardiac surgery.
Identifiants
pubmed: 36923547
doi: 10.12788/fp.0300
pii: fp-39-11s-s06
pmc: PMC10010497
doi:
Types de publication
Journal Article
Langues
eng
Pagination
S6-S11cInformations de copyright
Copyright © 2022 Frontline Medical Communications Inc., Parsippany, NJ, USA.
Déclaration de conflit d'intérêts
Author disclosures The authors report no actual or potential conflicts of interest or outside sources of funding with regard to this article.
Références
Ann Thorac Surg. 2016 Jan;101(1):56-63; discussion 63
pubmed: 26431924
Ann Thorac Surg. 2004 Nov;78(5):1528-34
pubmed: 15511424
Ann Thorac Surg. 2002 May;73(5):1472-8
pubmed: 12022535
J Am Coll Surg. 2013 Jun;216(6):1116-23
pubmed: 23619318
Crit Care Med. 2000 Dec;28(12):3847-53
pubmed: 11153625
Ann Thorac Surg. 2006 Mar;81(3):880-5
pubmed: 16488688
Eur J Cardiothorac Surg. 2009 Jul;36(1):35-9
pubmed: 19307134
Anesthesiology. 2010 Nov;113(5):1126-33
pubmed: 20966666
Eur J Cardiothorac Surg. 2018 Nov 1;54(5):896-903
pubmed: 29868854
Ann Thorac Surg. 2012 Jul;94(1):109-16
pubmed: 22579949
Heart. 2000 Apr;83(4):429-32
pubmed: 10722544
Circulation. 2010 Aug 17;122(7):682-9, 7 p following p 689
pubmed: 20679549
Ann Thorac Surg. 1994 Jan;57(1):12-9
pubmed: 8279877
Thorac Cardiovasc Surg. 2002 Apr;50(2):95-9
pubmed: 11981710
Crit Care Med. 1997 Apr;25(4):567-74
pubmed: 9142019
J Crit Care. 2015 Feb;30(1):13-8
pubmed: 25316527
Eur J Cardiothorac Surg. 2004 Feb;25(2):203-7
pubmed: 14747113
Ann Thorac Surg. 2010 Feb;89(2):490-5
pubmed: 20103328
Ann Intensive Care. 2018 Dec 17;8(1):127
pubmed: 30560526
Ann Thorac Surg. 2017 Jun;103(6):1893-1899
pubmed: 27938887
Ann Thorac Surg. 2013 Jul;96(1):15-21; discussion 21-2
pubmed: 23673073
Ann Thorac Surg. 2017 Apr;103(4):1270-1276
pubmed: 27938884
Anesth Analg. 2018 Jul;127(1):55-62
pubmed: 29324497
J Cardiothorac Vasc Anesth. 2016 Dec;30(6):1550-1554
pubmed: 27498267
Chest. 1997 Oct;112(4):1035-42
pubmed: 9377914
J Cardiothorac Surg. 2006 May 31;1:14
pubmed: 16737548
N Engl J Med. 2008 Mar 20;358(12):1229-39
pubmed: 18354101
JAMA. 2016 Apr 5;315(13):1354-61
pubmed: 26975498
J Cardiothorac Vasc Anesth. 2016 Dec;30(6):1555-1561
pubmed: 27720290